BlOL-Ufel 

LIBRARY 


Veterinary  Medicine  Series 
No.  3 


COLICS  AND  THEIR 
TREATMENT 


Edited  by 

D.  M.  CAMPBELL,  D.  V.  S. 

Editor,  American  Journal  of  Veterinary  Medicine 


CHICAGO 

American  Journal  of  Veterinary  Medicine 
1914 


yd*. 


Copyright,  1914 
D.  M.  CAMPBELL 


Kenfield  Leaeh  Co.,  Chicago 


Preface 

This  little  volume  appears  because  of  the  need  for 
the  material  which  it  contains  in  a  readily  accessible 
form.  An  examination  of  the  articles  in  this  work  will 
convince  anyone  that  they  are  too  important,  too  valu- 
able to  the  practitioner  and  too  much  needed  by  most 
of  us  to  remain  in  the  more  or  less  inaccessible  files  of 
any  periodical.  Therefore,  the  customary  apology  for 
the  issuance  of  a  publication,  that  usually  begins  its 
preface,  is  wholly  unnecessary  here. 

Many  veterinarians  apologize  for  the  use  of  the  word 
"colic"  and  deplore  its  introduction  into  the  nomen- 
clature of  diseases.  But  such  a  view  seems  hardly  jus- 
tified. It  appears  best  to  recognize  that  the  meaning 
of  this  term  has  traveled  far  beyond  its  logical,  etymo- 
logical restrictions  and  has  come  to  include  a  great, 
though  definite,  group  of  ailments,  which  bear  some 
degree  of  relation  to  one  another  in  cause  and  in  effect. 
Various  substitutes  for  the  word  colic  have  been  sug- 
gested by  writers  on  veterinary  medicine  but  as  yet  none 
of  the  terms  offered  is  so  comprehensive  and  at  the  same 
time  so  exclusive — none  includes  all  of  the  ailments  which 
it  is  desirable  to  place  in  this  class,  and  at  the  same  time 
omits  those  that  do  not  properly  belong  in  it.  There- 
fore, "Colics"  is  selected  as  the  most  significant  title 
available  for  this  work. 

May,  1914.  The  Editor. 


399055 


Importance  of  Clinical 
Reports 

CAREFUL  observation  makes  a  skilled 
practitioner,  but  his  skill  dies  with  him. 
By  recording  his  observations,  he  adds  to  the 
knowledge  of  his  profession,  and  assists  by  his 
facts  in  building  up  the  solid  edifice  of  patho- 
logical science."— William  Hunting,  F.R.C.V.S. 


Contents 


Page 
Introduction    11 

D.   M.  CAMPBELL 

Differentiation  of  the  Various  So-Called  Colics 15 

R.    P.   LYMAN 

Stomach  Lavage  in  Acute  Indigestion  of  the  Horse. .     37 

D.  O.    KNISELY 

Surgical  Treatment  of  Colics  in  Horses 53 

L.   A.   MERILLAT 

Impaction  of  the  Cecum  in  the  Horse tt5 

A.    T.    GILYARD 

Colics  in  the  Horse 101 

DAVID   S.    WHITE 

Medicinal  Treatment  of  Colic  in  the  Horse 113 

E.  L.   QUITMAN 


Introduction 

Unlike  most  other  ailments  of  animals,  the  treat- 
ment of  colics  in  horses  has  undergone  relatively  slow 
change  in  recent  years.  The  immense  forward  strides  in 
our  knowledge  of  the  science  of  bacteriology  has,  within 
a  generation,  revolutionized  prophalaxis  and  surgery, 
and  materially  changed  the  accepted  methods  of  diagnosis 
arid  treatment  of  infectious  disease ;  but  before  the  prob- 
lem of  preventing,  diagnosing  or  treating  the  colics  of 
the  horse  bacteriology  stands  helpless.  Epizootiology 
knows  no  means  of  forestalling  an  attack  of  colic,  the 
scientific  laboratory  knows  of  no  reaction  that  will  reveal 
its  presence  and  biologic  therapy  offers  no  aid  in  its 
treatment;  all  this  notwithstanding  this  ailment  occu- 
pies more  of  the  time  and  attention,  and  makes  greater 
demands  upon  the  skill  of  the  average  practitioner  of 
veterinary  medicine  than  any  other. 

Just  a  decade  ago  Reeks'  valuable  treatise  on  colics 
appeared,  and  marked  the  beginning  of  the  substitution 
of  stimulants  for  sedatives  in  the  treatment  of  this  ail- 
ment. That  many  of  the  followers  of  Reeks  went  to 
extremes  in  their  neglect  of  sedatives  in  the  treatment 
of  colic  is  certain,  and  it  is  equally  true  that  Reeks  advises 
the  use  of  stimulants  in  excessively  large  doses,  but  on 
the  whole  his  teaching  constituted  a  great  advance  in 
our  therapy. 

The  use  of  the  stomach  tube  in  the  treatment  of  colics 
of    the   horse   was    another   improvement    upon    exist- 


12  COLICS  AND  THEIR  TREATMENT 

ing  methods  fully  as  great  as  that  originated  by  Reeks. 
The  credit  for  the  introduction  of  the  stomach  tube  and 
its  popularizing  among  the  profession  of  America  is 
chiefly  due  to  Dr.  D.  O.  Knisely,  of  Topeka,  Kansas, 
who  by  his  continuous  and  persistent  advocacy  of  stom- 
ach lavage,  in  the  American  Journal  of  Veterinary 
Medicine,  at  all  seasons  and  at  all  times,  has  made  it  a 
recognized  treatment  for  colics  in  nearly  every  veterinary 
hospital  in  the  land.  Indeed  there  are  but  few  practition- 
ers in  this  country  who  do  not  possess  a  stomach  tube. 

Unfortunately,  Doctor  Knisely  has  not  been  able  to  con- 
vince the  profession  in  Europe  of  the  advantages  "of 
removing  the  cause  of  the  trouble  at  its  source  expedi- 
tiously, safely  and  surely,"  and  the  stomach  tube  is  now, 
ten  years  after  its  introduction,  almost  wholly  unknown 
and  unused  by  any  but  American  veterinarians. 

It  is  hoped  that  the  detailed  description  of  the  modus 
operandi  of  stomach  lavage,  given  in  this  work,  will  im- 
prove the  technic  of  many  whose  success  with  this  method 
of  treating  colics  has  not  been  as  great  as  it  should  be 
when  properly  carried  out,  and  that  others  who  have  not 
as  yet  employed  this  all  but  indispensable  contrivance  in 
the  treatment  of  colic  will  be  induced  to  use  it  by  the 
preponderance  of  testimony  to  its  efficacy. 

The  third  material  advance  in  the  treatment  of  colics 
during  a  generation  was  the  introduction  of  "E.  L. 
Quitman's  vest-pocket  stomach  tube,"  as  it  is  popu- 
larly named ;  i.  e.,  the  administration  of  an  antiferment 
that  is  really  effective  in  the  stomach  and  intestines — 
salicylic  acid.  This  treatment  is  not  employed  as  gen- 
erally as  its  value  merits  and  if  this  volume  accom- 


INTRODUCTION  13 

plishes  nothing  more  than  to  extend  widely,  a  knowl- 
edge of  this  treatment  its  existence  will  have  been 
amply  justified. 

The  description  of  surgical  methods  for  the  relief  of 
colics  in  horses  contains  much  that  is  new  to  many 
practitioners,  yet  these  methods  have  all  received  careful 
study  by  Dr.  L.  A.  Merillat,  who  by  personal  experience 
has  demonstrated  their  success  or  failure.  Their  adop- 
tion as  advised  by  Doctor  Merillat  will  lead  to  a  ma- 
terial improvement  in  the  general  treatment  of  colics. 

D.  M.  C. 


Differentiation    of  Various    So- 
Called  Colics  of  the  Soliped* 

BY  RICHARD  P.  LYMAN,  B.  S.,  M.  D.  V.    (HARV.) 

Dean    of    Veterinary    Science,    Michigan    Agricultural    College, 
East  Lansing,  Michigan 

It  is  not  my  purpose,  nor  is  it  considered  essential 
in  an  article  of  this  character,  to  consider  the  classical 
etiologic  factors,  general  symptomatology,  or  routine 
therapeutics.  The  omission  of  all  preliminaries  affords 
an  opportunity  to  turn  at  once  to  the  subject,  and  allows 
us  to  reason  out  first  the  "whyfor"  of  the  words,  "so- 
called  colics,"  before  launching  into  the  real  issue. 

SO-CALLED  FALSE  COLICS 

Probably  no  word  is  more  commonly  used  by  the  laity, 
and  also  (through  force  of  circumstance  and  habit) 
by  the  veterinarian,  in  referring  to  animal  diseases,  espe- 
cially diseases  of  the  horse,  than  the  word  "colic."  It  is 
used  to  indicate  a  condition  characterized  by  certain  evi- 
dences of  pain  that  is  by  no  means  always  correctly  at- 
tributed to  a  disturbance  within  any  one  group  of  organs ; 
we  find  "colicky"  manifestations  associated  with  per- 
verted respiratory,  urinary,  reproductive  and  digestive 
functions,  with  disturbances  of  the  muscular  system  and 
also  accompanying  certain  specific  and  general  systemic 
diseases.     When  purely  of  enteric  origin,  colic  is  classi- 


*Reprintecl   from  the   May,    1912,   issue   of  the   American   Journal   of   Vet- 
erinary Medicine. 


16  COLICS  AND  THEIR  TREATMENT 

cally  known  as  enteralgia,  this  is  "true  colic."  Other 
forms,  or  the  "false  colics/'  on  the  whole  are  less  intri- 
cate, and  these  will  first  occupy  our  attention.  Remember 
fhat  we  are  dealing  essentially  with  differentiating  facts, 
all  else  being  largely  omitted. 

Diseases  Manifesting  Colicky  Pains. 

Among  the  array  of  diseases  or  disturbances  coming 
more  especially  under  the  arbitrary  classification  of 
"false  colic"  may  be  cited  laryngeal,  pharyngeal,  and 
esophageal  troubles,  pleurisy,  strangles,  purpura  hemor- 
rhagica, influenza,  tetanus,  ruptured  stomach  or  di- 
aphragm, calculus,  or  obstruction  of  the  urethra  or 
ureters,  bladder  disturbances,  pregnancy,  azoturia,  pye- 
mia, chemical  or  vegetable  poison,  hepatic  ailments,  peri- 
tonitis and  enteritis,  hernia,  anemia,  etc. 

Many  of  the  aforementioned  diseases — strangles, 
equine  pleuro-pneumonia,  pyemia,  equine  pernicious 
anemia  (swamp  fever),  influenza,  purpura  hemorrhagica, 
tetanus  and  other  infective  maladies — manifest  abdom- 
inal pain  usually  of  secondary  character  and  comprise  a 
class  which  it  seems  unnecessary  to  discuss  further  be- 
yond emphasizing  that  the  pain  is  usually  coincident  with 
an  actual  enteralgia,  reasonably  inferring  that  complica- 
tions exist,  often  of  serious  nature  and  indicative  of  dis- 
turbances having  their  origin  in  intestinal  or  circulatory 
obstruction,  intestinal  catarrh  or  inflammation  through 
extension  or  intoxication,  or  again  in  nervous  irritability 
and  exhaustion. 

Prognostications  upon  these  complications  or  mani- 
festations of  pain  must  be  largely  determined  by  the 
severity  of  the  attack,  the  degree  of  impairment  of  the 


COLICS  OF  THE  SOLIPED  17 

nervous  system  and  the  physical  state  of  the  organism 
as  a  whole. 

Laryngeal,  pharyngeal  or  esophageal  stenosis  or  ob- 
struction, pregnancy,  retained  placenta  and  hernia  are 
unlikely  to  be  confused  with  colic  and  may  be  quickly 
disposed  of.  The  careful  practitioner  after  securing  a 
complete  history  of  any  of  these  cases  will  observe  in  the 
multiplicity  of  idiopathic  or  pathognomonic  symptoms 
adequate  means  for  their  differentiation  from  true  colic 
and  from  one  another. 

Colicky  Pains  from  Poisoning 

Grouping  next  the  various  poisonings  by  irritants — 
pathologic  conditions  produced  directly  by  irritant  inor- 
ganic and  organic  preparations,  of  the  latter  more  par- 
ticularly the  alipathic  and  cyclic  compounds  which  include 
certain  of  the  ammonia  derivatives,  as  amids,  alkaloids, 
ptomains,  and  toxins,  we  observe  that  as  far  as  their  ac- 
tion upon  the  digestive  tract  is  concerned,  they  produce 
lesions  and  symptoms  allied  or  identical  to  gastroenter- 
itis ;  hence,  we  will  include  them  and  for  the  moment 
consider  them  jointly  with  gastro-enteritis,  enteritis  and 
peritonitis  as  it  becomes  necessary  to  present  material 
sufficiently  competent  to  separate  them  collectively  or 
individually  from  the  condition  we  purpose  to  interpret 
as  true  colic. 

Of  course,  we  acknowledge  that  it  is  only  through 
broad  generalization  that  we  can  include  the  multiplicity 
of  morbid  conditions  arising  from  these  causes  into  a 
summary  of  one  or  even  two  types  of  disease.  Such  lib- 
erties are  taken  through  assuming  that  the  reader  is  aware 
that  poisoning  exhibits  certain  characteristics  aside  from 


IS  COLICS  AND  THEIR  TREATMENT 

those  of  disturbance  of  the  intestinal  or  gastric  appara- 
tus ;  these  symptoms,  naturally,  do  not  concern  us  at  this 
time  beyond  the  knowledge  that  the,y  furnish  means  of 
differentiating  these  forms  of  enteric  disturbance  from 
true  colic. 

Colicky  Symptoms  Due  to  Enteritis 

In  enteritis  the  pains  are  symtomatic,  continuous,  the 
pulse  is  not  squirty  as  with  many  colics,  but  quick- 
ened, small  and  so  faintly  perceptible,  because  of  the 
systemic  shock  and  coincident  vasomotor  disturbance,  as 
to  be  distinguished  with  difficulty.  The  temperature  is 
elevated  considerably  above  that  usually  produced  as  a 
result  of  the  violent  exertions  of  genuine  colic;  there  is 
injection  of  the  conjunctivae  which  have  the  hue  of  raw 
beefsteak;  a  prostration  altogether  too  profound  and  of 
too  rapid  onset  for  ordinary  colic  but  such  as  might  be 
mistaken  only  for  that  colic  accompanying  rupture  or 
strangulation  of  a  vital  organ.  In  prostration  from  en- 
teritis, however,  there  is  lacking  that  peculiar  period  of 
anxiety  and  quietness  which  accompanies  rupture  of  a 
vital  organ.  The  pains  are  intermittently  constant;  the 
movements  of  an  animal  are  more  considerate,  and  do 
not  manifest  careless  tumbling  about,  but  constantly  ex- 
press soreness. 

Colicky  Pains  Due  to  Peritonitis 

Peritonitis  is  even  more  difficult  than  enteritis  to 
separate  from  true  enteralgia.  The  somewhat  wiry 
though  small  and  increased  pulse  is  an  aid  to  is  differen- 
tiation as  is  also  the  restlessness,  and  tjie  manifestations 
of  sensitiveness  of  the  abdomen  which  are  more  intensive 
than  in  enteritis,  rather  approaching  true  colic.    Absolute 


COLICS  OF  THE  SOLIPED  19 

differentiation  of  peritonitis  from  true  colic  is  not  always 
possible  during  life  and  especially  is  this  the  case  during 
the  earlier  periods  of  the  attack. 

Differentiation  from  Disturbances  of  the  Urinary 
System 

For  distinguishing  those  false  colics  attributed  rightly 
to  troubles  within  the  urinary  system,  viz. :  acute 
nephritis,  calculi  of  ureters,  urethra  or  bladder  disturb- 
ances, recourse  must  be  had  to  the  evidence  collected 
through  manual  exploration  through  the  rectum,  which 
in  severe  or  uncertain  colics  is  never  omitted  by  the 
painstaking  diagnostician;  furthermore,  catheterization 
will  often  uncover  a  hidden  diagnosis. 

During  the  manipulative  work  one  must  not  fail  to 
take  cognizance  of  the  value  of  certain  features  as  ac- 
cumulative evidence;  I  refer  especially  to  a  degree  of 
sensitiveness  of  the  kidneys  or  bladder,  evidenced  by 
flinching  on  pressure;  the  amount  of  urine  within  the 
bladder  considered  jointly  with  history  of  manner  of  void- 
ing, whether  free  or  limited  micturition  or  constant 
straining  but  suppression;  information  gained  through 
locating  foreign  substances  that  may  impede  one  or  both 
of  the  ureters,  or  the  urethra  or  lie  in  the  bladder,  like- 
wise a  history  of  periodicity,  the  passing  of  blood-dis- 
colored urine,  fecal  movements  and  chemical  or  micro- 
scopical examination  of  the  fluid  passed. 

Differentiation  from  Hepatic  Disease 

Disturbances  of  the  liver  in  the  horse  have  been 
given  little  heed  in  veterinary  medicine  possibly  on  ac- 
count of  the  indefinite  character  of  the  symptoms  and 


20  COLICS  AND  THEIR  TREATMENT 

because  even  the  trained  observer  finds  it  difficult  to 
make  a  clear  and  entirely  satisfactory  differentiation  be- 
tween the  various  functional  and  organic  hepatic  troubles. 
There  are,  however,  certain  signs,  in  protracted  illness, 
that  point  to  probable  hepatic  derangement,  viz. :  extreme 
depression,  pronounced  immobility,  slight  periodic  un- 
easiness, elevation  of  temperature,  possibly  icterus  and, 
in  cases  of  hepatic  abscess,  increased  phagocytosis  as  de- 
termined by  a  blood  count. 

Dangers  in  "Home  Made"  Diagnoses 

Nothing  is  more  common  than  for  the  practitioner 
to  be  called  upon  to  attend  a  horse  described  as  having 
"kidney  trouble"  or  ''trouble  with  his  water."  This  con- 
clusion, indeed  confusion,  of  the  untrained  observer  is 
quite  natural  because  of  the  frequency  with  which  the 
suffering  animal  assumes  an  attitude  indicative  of  a  de- 
sire to  micturate;  rarely  voiding  any  urine,  the  action 
being  due  usually  to  an  irritation  of  the  bladder  from 
bowel  pressure,  or  because  the  stretching  gives  temporary 
ease. 

The  wily  practitioner  will  not  be  misguided  by  the 
"home-made"  diagnosis,  but  will  through  his  trained 
manipulations,  observations  and  a  historical  resume  ex- 
ercise painstaking  efforts  and  thoroughness  to  refute  or 
affirm  the  opinions  expressed,  remembering  throughout 
the  examination  of  the  patient  the  possibility  of  the  ab- 
sence of  certain  important  symptoms  that  are  masked 
consequent  upon  previous  administration  of  medicines 
given  by  the  owner  or  caretaker  in  a  usually  misguided 
effort  to  effect  a  cure. 


COLICS  OF  THE  SOLIPED  21 

Differentiation  from  Hemoglobinemia 

Let  us  now  turn  to  azoturia  as  the  one  remaining 
disease  having  symptoms  allied  to  true  colic  to  which  I 
wish  at  this  time  to  call  your  attention.  Hemoglobi- 
nemia is  typically  distinctive  as  the  disease  progresses  to 
greater  severity  or  duration,  and  after  the  paresis  of  the 
crural  muscles  appears,  and  the  gluteal  group  becomes 
rigid  and  enlarged  or  if  other  groups  are  affected  after 
they  become  similarly  involved. 

A  differentiation  may  also  be  made  through  the  dis- 
covery of  the  typical  high-colored  urine ;  absence  of  pain 
and  return  of  appetite,  together  with  the  history  of  high 
feeding,  a  short  rest,  exercise,  sudden  onset  and  lame- 
ness which  is  so  consistently  diagnostic. 

The  primary  expressions,  however,  in  azoturia  and 
enteralgia  are  conflicting  in  many  instances,  particularly 
in  those  cases  seen  during  the  initiatory  pain  or  muscular 
spasm,  when  the  anxious  and  excited  animal  sweats  pro- 
fusely, breathes  excitedly,  becomes  restless,  lies  down, 
rolls,  rises,  or  if  unable  to  get  up,  flounders  heavily  from 
place  to  place  or  side  to  side  with  accompanying  con- 
vulsive movements,  quickened  pulse  and  peristalsis  ap- 
parently suppressed  through  involvement  of  the  sympa- 
thetic nervous  system. 

It  is,  therefore,  evident  that  a  careless  examination 
may  easily  lead  to  error  that  would  not  be  made  by  the 
painstaking  diagnostician. 

Differentiation  from  Pectoral  Ailments 

Pleurisy  is  another  condition  that  is  altogether  too 
frequently  overlooked  by  writers  who  attempt  to  differ- 
entiate true  and  false  colic.     The  practitioner  who  casts 


22  COLICS  AND  THEIR  TREATMENT 

his  lot  where  the  business  of  importing  and  selling  "green 
horses"  assumes  any  magnitude,  soon  has  occasion  to 
realize  the  great  superficial  similarity  between  equine 
restlessness  caused  by  actual  colic  and  that  consequent 
upon  the  early  beginnings  of  pleurisy  or  pectoral  influ- 
enza ;  indeed,  one  observes  as  allied  symptoms ;  the  rest- 
lessness, tucked  up  abdomen,  pawing,  looking  at  flank, 
and  anxiety  and  a  mistaken  diagnosis  is  frequently  made. 

Many  times  in  my  career  as  a  practitioner  have 
horses  been  sent  to  my  hospital  preceded  by  the  tele- 
phone message  or  relinquished  to  my  care  by  the  state- 
ment, "The  animal  has  a  slight  colic ;  as  soon  as  it  is  over 
let  us  know  and  we  will  send  for  him."  A  look  at  the  ani- 
mal and  compilation  of  the  history  obtainable  prompts  a 
general  examination  rather  than  one  confined  solely  to  the 
abdomen,  and  as  a  result  certain  symptoms  are  discov- 
ered that  when  considered  in  conjunction  with  the  anam- 
nesis furnish  a  diagnosis  of  this  type  of  false  colic. 

The  differentiating  symptoms  of  pleurisy  are:  a 
characteristic  wiry  pulse;  possibly  a  precursory  chill; 
elevated  temperature,  in  these  early  stages  usually  con- 
siderably above  normal;  a  tucked-up  abdomen  with  the 
characteristic  pleuritic  ridge  extending  from  the  ends  of 
the  false  ribs  to  the  flank ;  abnormal  thoracic  auscultation 
sounds  and  painful  expressions  upon  forced  movement, 
or  upon  costal  percussion,  all  clearly  demonstrating,  after 
systematic  study  of  the  case,  that  there  is  actually  no 
intimate  similarity  to  enteralgia  but  emphasizing  the  value 
of  never  allowing  an  opinion  to  become  fixed  until  a 
thorough  investigation  of  all  details  has  been  completed ; 
a  positive  diagnosis  earlier  will  many  times  lead  to  em- 
barrassment. 


COLICS  0:F  THE  SOLIPED  23 

Other  Disturbances  Simulating  Enteralgia 
In  leaving  the  subject  of  false  colics  at  this  point, 
of  course  it  is  admitted  that  greater  completeness  would 
be  accomplished  did  space  permit  me  to  consider  several 
other  maladies  with  manifestations  conflicting  in  part. 
Fearing,  however,  to  weary  the  reader  with  unneces- 
sary, though  not  wholly  irrelevant,  detail,  we  may  pass 
them  over  by  simply  suggesting  the  possibility  of  error 
from  iliac  or  femoral  thrombosis,  cerebral  derangement, 
foot  trouble  or  from  open  synovial  sacs,  as  well  as  from 
rupture  of  the  stomach  and  diaphragm. 

CONSIDERATION  OF  TRUE  COLICS 

We  have  now  to  consider  true  colics.  As  altered 
function  of  the  stomach  either  independently  or  jointly 
with  the  bowels  may  occasion  pains  akin  or  identical  to 
colic,  I  am  prompted  to  give  a  broader  interpretation  to 
the  word  than  is  inferred  by  enteralgia  and  include  in 
this  discussion  certain  gastric  disturbances  quite  inti- 
mately associated  with  colics  of  the  soliped. 

It  would  appear  to  be  impossible  to  intelligently 
diagnose  colic  if  one  expected  in  all  instances  to  discover 
each  and  every  symptom  cited  by  various  authors;  in- 
deed, there  is  much  irregularity  among  the  varieties  of 
colic  in  the  manner  of  their  expression.  Some  symp- 
toms prominent  in  one  instance  are  entirely  absent  in 
another.  Right  here  is  emphasized  the  value  of  adopt- 
ing a  methodical  system  of  examination,  and  the  import- 
ance of  differentiation;  for  naturally  lucid  understanding 
of  the  nature  of  the  painful  condition  will  very  materially 
aid  in  lessening  mortality  where  the  accepted  death  rate 
is  seemingly  excessive. 


24  COLICS  AND  THEIR  TREATMENT 

To  handle  more  intelligently  the  work  at  hand,  we 
will  group,  as  is  customary  with  writers  upon  veterinary 
medicine,  the  several  varieties  of  true  colic  which  it  is 
our  purpose  to  consider.  The  classification  that  appeals 
most  to  the  writer  is  a  modification  of  those  adopted  in 
Hayes'  translation  of  Friedberger  and  Frohner's  "Vet- 
erinary Pathology"  and  by  Reeks  in  his  excellent  work 
upon  "Colics  of  the  Horse."  Without  attempting  to  ad- 
here absolutely  to  the  details  in  either  instance  but  ac- 
knowledging the  basis  mentioned  for  the  classification, 
we  present  the  following  groups,  viz. : 

1.  Colic  due  to  engorgement. 

2.  Colic  due  to  intestinal  and  mesenteric  obstruction. 

3.  Gaseous  colic. 

4.  Spasmodic  colic. 

5.  Verminous  colic. 

Engorgement  Colics 

1. — Gastric  Impaction. — We  will  first  consider  en- 
gorged stomach,  called  also  stomach  staggers,  gastric 
impaction  or  vertigo.  There  is  usually  a  history  of  glut- 
tony; possibly  the  horse  has  slipped  his  halter  or  gained 
freedom  through  an  open  stable  or  stall  door  or  from  a 
pasture  enclosure  or  otherwise  and  thus  had  access  to 
some  especially  palatable  growing  food  or  the  grain  bin. 

Having  eaten  to  over-indulgence  the  animal  appears 
especially  dull,  full-bodied  and  exhibits  every  evidence 
of  reflex  brain  pressure,  leans  heavily  against  the  wall  of 
the  stall  or  rests  the  head  upon  the  edge  of  the  manger. 
The  pains  are  slow  to  set  in,  mild  at  first  but  gradually 
increase  in  intensity  until  they  become  a  steady  grind,  but 


COLICS  OF  THE  SOLIPED  25 

like  all  colics  of  this  group  they  are  never  excruciating 
unless  gaseous  complications  develop. 

2. — Impaction  of  the  Small  Intestine. — Overloading 
of  the  small  intestine  presents  a  line  of  symptoms 
not  unlike  those  observed  in  certain  forms  of  im- 
paction or  obstruction  of  the  floating  colon,  and  it  is 
often  quite  impossible  to  determine  with  certainty  which 
condition  actually  exists  until  after  a  careful  and  intelli- 
gent rectal  examination  has  given  a  basis  for  differen- 
tiation. 

In  the  beginning  of  cases  of  engorgement  of  the 
small  intestines  the  discomfort  is  protracted,  persistent 
and,  although  the  pains  are  of  rather  sudden  onset  after 
eating,  especially  if  impaction  is  near  the  stomach,  they 
are  of  the  mild  type  with  intermittent  spells  of  greater 
uneasiness.  The  patient  seeks  recumbency  for  extended 
intervals,  often  shows  icterus,  and  diarrhea  is  frequently 
observed,  though  rectal  examination  demonstrates  these 
parts  to  contain  fecal  matter  in  more  or  less  solid  state. 
The  fecal  passages  are  foul-smelling  and  usually  pre- 
ceded by  pain.  A  better  appetite  is  observed,  during  the 
early  beginning  of  this  than  with  most  other  colics,  and 
there  is  an  almost  diagnostic  inclination  to  move  back- 
ward as  if  endeavoring  to  get  free  from  the  gradually 
increasing  pressure.  Prompt  diagnosis  has  much  to  dc 
with  lessening  the  possibility  of  a  grave  termination 
through  the  development  of  enteritis  or  bowel  rupture. 

3. — Impaction  of  Cecum  and  Colon. — There  yet 
remains  two  very  distinct  portions  of  the  intestinal 
viscera  to  be  considered  before  leaving  the  subject  of 
colics  due  to  overloading — the  cecum  and  large  or  folded 


26  COLICS  AND  THEIR  TREATMENT 

colon.  Experience  has  led  me  to  believe  that  disturb- 
ances of  the  former  are  exceedingly  difficult,  if  indeed 
they  are  not  impossible  to  clearly  differentiate  from 
trouble  involving  the  folded  colon,  unless  at  times  dis- 
tinguishable through  the  exceedingly  protracted  period- 
ical character  of  the  pains  and  by  rectal  exploration.  In 
spite  of  this  admission  I  believe  it  is  quite  within  our 
rights  to  suggest  that  the  cecum  is  susceptible  to  dis- 
turbances allied  to  those  occurring  in  the  colon  and 
though  painstaking  postmortem  examinations  have 
failed  to  reveal  cecal  impactions  to  an  extent  of  over- 
loading. I  have,  on  the  other  hand,  found  rupture  of 
that  viscera  presumably  as  a  result  of  fecal  stasis  or  of 
gaseous  accumulation,  and  believe  the  constant  stretch- 
ing of  the  walls  of  the  cecum,  together  with  pressure,  so 
impairs  the  local  nutrition  as  to  prompt  necrotic  areas 
which  readily  account  for  the  rupture. 

Considering  jointly  possible  impaction  of  the  cecum 
and  engorgement  of  the  folded  colon  from  an  abnormal 
accumulation  of  ingesta,  we  observe,  together  with  the 
general  symptoms  of  colic,  manifest  by  mild  periodic, 
colicky  pains,  a  fullness  of  the  abdomen,  bracing  of  the 
hind  parts  heavily  against  a  convenient  wall,  couching 
walk  and  hesitancy  in  lying  down,  diminished  peristaltic 
sounds  and  on  rectal  exploration  a  firm  consistency  of 
the  accumulated  mass  as  well  as  a  displacement  of  the 
pelvic  flexure  of  the  colon,  which  in  these  cases  lies 
somewhat  to  the  left  of  the  rectum,  having  presumably, 
as  a  result  of  its  gravid  state,  become  moved  from  the 
normal  position  which  is  somewhat  more  anterior  and 
superior.    The  history  of  enforced  idleness  and  free  feed- 


COLICS  OF  THE  SOLIPED  27 

ing  may  quite  frequently  be  competently  applied  to  the 
general  summary  of  etiology  and  symptomatology  of  en- 
gorgement of  the  large  intestines. 

Obstruction  Colics 

Intestinal  colics  that  it  is  desired  to  classify  under 
this  heading  are  grouped  by  Reeks  under  "acute  intes- 
tinal obstruction"  in  contradistinction  to  engorgement 
colic  already  considered,  which  he  styles  "sub-acute  ob- 
struction." Experience  amply  demonstrates  that  the 
etiologic  factors  contributory  to  the  development  of  these 
kinds  of  colicky  pains  are  multiple  and,  moreover,  that 
they  may  in  many  instances,  at  least,  be  primarily  attrib- 
uted to  overeating.  Among  the  disturbances  belonging 
to  this  group  we  include  colics  due  to  foreign  substances, 
neoplasms,  abscesses,  displacement,  volvulus,  intussus- 
ception or  invagination,  stricture,  paralysis  and  obstruc- 
tion from  accumulated  ingesta  in  the  floating  colon. 

Owing  to  the  tendency  of  the  coarser  particles  of  the 
food  to  accumulate  anterior  to  the  seat  of  obstruction, 
these  colics  are  in  a  manner,  at  least,  allied  to  those  of 
the  engorgement  group,  but  are,  however,  distinguished 
by  their  acuteness  contrasted  with  the  slow  grinding  pains 
of  engorgement. 

Some  of  these  conditions  are  rare,  not  readily  dis- 
cernable  unless  through  rectal  exploration,  but  apparently 
capable  in  each  instance,  of  altering  the  symptoms  to  some 
extent,  depending  upon  the  character  of  ingesta  and  con- 
sistency of  the  visceral  contents.  Little,  if  any,  attempt 
has  thus  far  been  made  to  clearly  distinguish  one  form 
of  obstruction  colic  from  another. 


28  COLICS  AND  THEIR  TREATMENT 

1. — New     Growths,     Foreign     Substances,     Etc. — 

Foreign  substances,  including  calculi,  hairballs,  sand, 
gravel,  or  other  extraneous  and  indigestible  materials, 
growths  in  the  form  of  tumors  or  abscesses  seldom  give 
rise  to  signs  having  any  definite  diagnostic  value,  and 
oftentimes  it  is  only  through  postmortem  examination, 
perhaps  following  death  from  some  other  cause,  that  we 
discover  the  actual  nature  of  a  condition  that  has  been 
conducive  to  periodic  attacks  of  enteralgia. 

At  such  time  a  review  of  the  case  furnishes  sufficient 
information  to  substantiate  the  belief  that  intestinal 
trouble  has  existed  for  a  considerable  period;  the  his- 
torical resume  of  such  cases  show  that  the  horse  has  not 
been,  in  most  instances  at  least,  an  easy  keeper,  has  in- 
clined toward  loss  of  flesh  under  the  least  provocation; 
has  been  subject  to  periodic  attacks  of  colic  that  have 
been  as  spontaneous  in  their  disappearance  as  unaccount- 
able in  origin;  straining  intervals,  with  periods  of  con- 
stipation are  not  infrequently  followed  by  diarrhea. 

Should  an  abscess  develop  well  toward  the  rectum, 
switching  and  restlessness  of  the  tail  and  general  un- 
easiness are  frequent,  especially  when  the  lower  bowel 
is  impacted  anterior  to  the  obstruction.  I  well  recollect 
one  case  of  abscess  formation  in  particular  that  came  to 
my  observation  and  that  had  its  origin  as  a  result  of  mal 
address,  in  which  the  injury  to  the  rectal  mucous  mem- 
brane was  associated  with  symptoms  just  detailed  and 
which  invariably  ceased  after  removal  of  the  crowding 
fecal  collections. 

2. — Obstruction  with  Paralysis. — Intestinal  par- 
alysis, particularly  when  involving  the  lower  bowel,  has 


COLICS  OF  THE  SOLIPED  29 

similar  symptoms,  associated  with  a  straddling  attitude^ 
elevated  tail  and  dropping,  at  frequent  and  irregular  in- 
tervals, of  scattered  particles  of  alvine  material,  together 
with  entire  absence  of  pain  upon  artificially  emptying  the 
crowded  rectum. 

3. — Obstruction  Due  to  Displacement. — Colics  of 
displacement  have  their  origin  more  especially  through 
escape  of  a  portion  of  the  bowel  following  diaphragmatic 
or  mesenteric  rupture,  in  inguinal  or  scrotal  hernia,  and 
also  volvulus  may  for  simplicity  be  included  under  this 
group,  the  latter  constituting  either  a  simple  or  multiple 
torsion,  twisting  or  knotting  of  one  portion  of  the  bowel 
upon  its  mesenteric  axis  or  around  the  loop  of  another 
portion;  either  condition  prompted  through  irregular 
peristalsis  and  varying  weight  of  the  contents  of  adjacent 
regions  of  the  tract.  Volvulus  can  occur  in  any  part  of 
the  tract,  but  more  constantly  in  the  ileum  of  the  small 
intestines,  the  double  or  floating  colon. 

These  displacements  may,  under  certain  influences, 
be  differentiated  one  from  another  by  intelligent  rectal 
or  scrotal  examination.  Collectively  they  are  character- 
ized primarily  by  intermittent,  sharp  spasmodic  pains 
that  increase  in  duration  and  intensity,  causing  ultimately 
the  most  violent  demonstrations,  with  entire  disregard 
to  self-inflicted  injury.  The  animal  moves  about  with 
a  head-shaking,  swaggering,  straddling  gait.  When 
standing  it  inclines  to  move  backward;  has  an  anxious 
look;  a  weak  pulse  and  progresses  rapidly  toward  col- 
lapse, with  relapse  of  pain  just  prior  to  death,  which 
finally  results  from  shock,  intestinal  or  mesenteric  stran- 
gulation, internal  hemorrhage,  peritonitis  or  enteritis. 


30  COLICS  AND  THEIR  TREATMENT 

4. — Intussusception.  —  Intussusception  is  another 
form  of  obstruction  colic  characterized  by  violent  and 
excrutiating  pain ;  it  is  also  called  invagination  or  indigi- 
tation,  and  probably  occurs  with  greater  frequency  than 
is  popularly  supposed.  Four  forms  of  this  classification 
are  listed  among  writers  upon  intussusception,  viz. :  First, 
a  telescoping  of  one  portion  of  the  small  intestine  into 
another,  ileal;  second,  passage  of  the  ileum,  together 
with  the  ileocecal  valve,  into  the  cecum,  ileocecal;  third, 
passage  of  a  portion  of  the  large  intestine  into  itself, 
colic;  and  fourth,  passage  of  the  ileum  into  the  opening 
of  the  colon,  ileocolic. 

Here  the  symptoms  of  pain  incident  to  the  convul- 
sive contractions  are  closely  allied  to  those  detailed  for 
intestinal  displacement,  but  with  a  somewhat  longer  dura- 
tion ;  violent  straining,  often  associated  with  the  passage 
of  blood-stained  particles  of  fecal  matter.  The  ultimate 
strangulation  is  less  sudden,  and  the  period  of  ease  is 
more  protracted,  prior  to  the  excitement  premonitory  to 
final  collapse.  In  those  cases  of  favorable  termination 
there  may  eventually  be  discovered  in  the  alvine  dis- 
charges the  cylindrical  portion  of  the  tract  that  has  be- 
come necrotic  and  sloughed  off  simultaneously  with  the 
new  union  between  the  opposing  peritoneal  surfaces  at 
the  anterior  circumference  of  the  prolapsed  portion. 

5.— Obstruction  of  Small  Colon.— During  my 
references  to  overloading  of  the  small  intestines  the  re- 
mark was  made  that  it  "presents  a  line  of  symptoms  not 
unlike  those  observed  with  obstruction  of  the  floating 
colon"  and  "careful  rectal  examination  gives  basis  for 
differentiation."     This  must  be  borne  in  mind  now  that 


COLICS  OF  THE  SOLIPED  31 

we  are  to  consider  obstruction  of  the  small  colon  which 
is  one  of  the  most  common  and  most  dangerous  of  the 
prolonged  colics,  often  extending  uninterruptedly  for 
twenty-four  to  thirty  hours. 

The  pains  are  continuous,  of  considerable  intensity 
and  accompanied  by  peculiar  stretching  forward  of  the 
front  limbs  and  backward  on  the  toes  of  the  hind  feet; 
also  by  violent  straining  either  during  recumbency  or 
when  standing.  There  is  a  tendency  for  gas  to  collect 
anterior  to  the  stoppage ;  a  frequent  passing  of  small  par- 
ticles of  fecal  matter,  and  the  gas  is  expelled  in  a  rather 
characteristic  snapping-like  manner  in  contradistinction 
to  the  prolonged  blowing  of  ordinary  unobstructed  flat- 
ulency. 

Like  in  other  forms  of  colic  of  this  class,  should  the 
obstruction  interrupt  the  visceral  circulation  sufficiently 
to  produce  strangulation,  there  occurs  a  period  of  anxi- 
ety free  from  pain,  that  just  prior  to  death,  is  interrupted 
by  tremors,  cold  sweating  and  renewed  pain.  Rectal  ex- 
amination may  aid  in  detecting  this  obstruction.  This 
manipulation  causes  excessive  pain,  straining,  a  tendency 
to  rise  on  the  toes  of  the  hind  feet  and  the  rectum  gives 
to  the  hand  a  feeling  of  tightness. 

6. — Embollic  or  Aneurysmal  Colics. — As  a  result 
of  aneurysm  or  thrombosis  of  one  or  another  branch 
of  the  mesenteric  arteries,  especially  consequent 
upon  helminthiasis,  we  encounter  a  number  of  cases  of 
enteralgia,  particularly  in  older  horses,  but  not  entirely 
confined  to  animals  of  mature  age.  These  manifestations 
though  on  the  whole  lacking  distinction,  and  resembled  by 
symptoms  observed  in  other  varieties  of  true  obstruction 


32  COLICS  AND  THEIR  TREATMENT 

colic,  are  possibly  best  characterized  as  being  quite  gen- 
erally protracted  with  unaccountable  intermittent  evi- 
dences of  severe  pain,  unthriftiness  and  susceptible  to 
fatal  strangulatory  complications. 
(Gaseous  Colic 
Referring  now  to  that  group  which  we  have  advis- 
edly styled  ''gaseous  colics,"  a  knowledge  of  anatomy 
will  readily  afford  opportunity  to  realize  the  possibility  of 
no  less  than  five  varieties  and  each  subject  to  sequelae 
of  the  gravest  consequence,  particularly  rupture  and  suf- 
focation. Three  forms  I  wish  especially  to  call  to  your 
attention  are : 

1.  True  gastric  tympany. 

2.  False  gastric  tympany. 

3.  True  flatulent  colic. 

1. — True  Gastric  Tympany. — Gaseous  distension 
of  the  stomach,  if  not  the  most  serious,  may  rightly 
be  classified  among  the  disturbances  of  grave  character, 
owing  to  its  frequency  and  liability  to  terminate  fatally 
in  a  short  time.  Here  the  practitioner  is  called  upon  to 
demonstrate  his  capabilities  and  in  a  vast  majority  of 
communities  his  reputation  will  be  in  direct  ratio  to  his 
success  in  dealing  with  acute  indigestion.  Primarily  this 
colic  comes  on  suddenly,  is  associated  with  a  history  of 
a  rapidly-eaten  meal  upon  either  an  empty  stomach  or 
by  a  tired  animal.  Within  the  stomach  there  is  a  mix- 
ture of  undigested  food  and  more  or  less  rapidly  ac- 
cumulating gas. 

Unless  dulled  by  the  indiscreet  administration  of 
anodynes,  the  patient  exhibits  a  rather  uniform  line  of 
symptoms,  viz. :  sudden    onset,    tremors    of    flank    and 


COLICS  OF  THE  SOLIPED  33 

humeral  muscles ;  profuse  general  perspiration,  becoming 
patchy;  with  manifestations  of  extreme  pain;  couching 
walk;  dog-sitting  attitude  and  general  fullness  of  abdo- 
men. Brown-red  nasal  discharge  and  salivation,  together 
with  belchings  of  foul-smelling  gas,  later  retching,  which 
at  times  constitutes  an  actual  vomit;  tossing  of  head  and 
elevation  of  the  upper  lip,  exposing  the  incisors ;  anxious 
look;  dilated  nostrils  and  a  peculiar  catchy,  sobbing  res- 
piration induced  through  diaphragmatic  pressure;  per- 
istalsis is  diminished  but  continues,  and  the  use  of  the 
trocar  and  canula  fails  to  relieve,  though  some  gas  may 
escape.  The  gait  becomes  uncertain  and  following  a 
period  of  the  most  excruciating  pain,  the  animal  dies  of 
suffocation,  rupture  of  the  stomach  or  nervous  collapse, 
without  that  period  of  dullness  characteristic  of  stran- 
gulation. When  attempting  to  give  liquids  by  the  mouth 
note  a  tendency  of  the  patient  to  crowd  forward  when 
the  head  is  elevated;  likewise,  a  disinclination  or  an  ap- 
parent inability  to  swallow  owing  to  the  distension  of  the 
stomach. 

2. — False  Gastric  Tympany. — False  gastric  tym- 
pany is  an  accumulation  of  gas  involving  more  es- 
pecially the  diaphragmatic  flexion  of  the  great  colon.  As 
a  result  of  pressure  exerted  upon  the  stomach  and  dia- 
phragm, an  animal  suffering  with  this  complaint  presents 
symptoms  that  are  quite  similar  to  the  foregoing,  hence 
my  designation  "false  gastric  tympany."  A  differentia- 
tion is,  however,  quite  possible;  the  gulping  is  odorless, 
the  breathing  labored,  but  free  from  sobbing,  and  there 
is  an  escape  of  an  abundance  of  gas  per  rectum  and 
a  tendency  to  greater  comfort  following  enterocentesis. 


34  COLICS  AND  THEIR  TREATMENT 

3. — True  Flatulency. — Flatulent  colic  or  the  evo- 
lution of  gas  within  the  intestinal  canal,  not  necessarily 
confined  to  any  one  particular  locality,  is  usually  char- 
acterized by  rotundity  of  the  abdomen,  more  especially 
at  the  flanks.  Tinkling  sounds  replace  the  absent  peri- 
staltic murmurs ;  the  pain  is  distressing  but  varying  with 
the  tenseness  of  walls;  breathing  is  labored  and  cyanosis 
ensues  if  not  relieved.  Flatus  escapes  from  the  anus  in 
blasts  in  contradistinction  to  the  previously  described 
interrupted  sounds  accompanying  obstruction. 

Rectal  exploration  and  flank  or  intra-rectal  tapping  es- 
tablishes the  diagnosis  if  it  is  not  otherwise  determined 
through  history  and  symptoms. 

Spasmodic  Colic 

Long  before  any  attempt  was  made  to  classify  true 
colics;  either  through  etiologic  or  pathologic  means, 
practitioners  of  equine  medicine  recognized  symptomat- 
ically  two  forms  of  intestinal  pain,  viz. :  flatulent  and 
spasmodic.  After  having  come  to  a  more  lucid  under- 
standing of  the  varieties  of  colic  and  though  inclined 
to  place  less  stress  upon  the  distinction  "spasmodic,"  we 
must  yet  admit  the  occurrence  of  large  numbers  of  cases 
unassociated  with  either  impaction,  obstruction  or  gas 
accumulation,  and,  moreover,  that  cannot  be  correctly 
attributed  to  intestinal  parasites  or  mesenteric  aneurism. 
These  conditions  are  probably  the  result  of  temporary 
derangement  of  the  sensory  nerves  producing  irregular 
peristalsis  through  stimulation  of  certain  areas  of  the 
unstriated  muscular  coats  of  the  intestinal  viscera,  par- 
ticularly within  the  small  intestines. 


COLICS  OF  THE  SOLIPED  35 

The  pains  are  sharp  and  diagnostically  intermittent, 
alternating  with  periods  of  what  seem  to  be  perfect 
health ;  the  abdomen  has  a  tucked-up  pleuritic  look ;  peri- 
stalsis is  augmented,  causing  abnormal  intestinal  sounds 
of  a  metallic  character;  diarrhea  often  becomes  an  asso- 
ciated symptom  and  though  spasmodic  colic  will  not,  as 
a  rule,  cause  great  concern,  it  may  lead  to  ruptures,  vol- 
vulus or  intussusception,  consequently  it  should  be  seri- 
ously regarded  in  those  instances  where  pain-free  inter- 
vals become  shortened,  alternated  with  lengthening  pe- 
riods of  uneasiness  of  increasing  severity. 

Verminous  Colic 

This  paper,  did  time  permit,  could  even  yet  be  am- 
plified to  greater  completeness  were  I  to  include  rupture 
of  the  stomach,  bowel  and  diaphragm  and  other  espe- 
cially applicable  conditions,  but  having  already  carried 
my  remarks  beyond  all  conservatism,  I  must  close  with 
but  the  briefest  reference  to  verminous  colic  resulting 
from  an  intestinal  invasion  of  lumbricoids,  particularly 
certain  of  the  ascaridae,  oxyuridse  and  strongylidae. 

The  pains  in  colics  from  these  causes  are  usually 
recurrent  and  mild  unless  associated  with  severe  disturb- 
ance of  the  mucosa.  As  differentiating  symptoms  we 
may  mention  chronicity,  emaciation  and  the  discharge  of 
ova  and  of  mature  parasites  per  rectum. 


Stomach  Lavage  in  Acute  Indi- 
gestion of  the  Horse* 

D.  0.  KNISELY,  D.  V.  Sv  TOPEKA,  KANSAS. 

With  this,  as  with  many  other  ailments  of  the  horse, 
we  have  several  different  phases,  which  differences  we 
are  unable,  in  many  cases,  to  adequately  explain.  With- 
out attempting  to  explain  them  I  shall  try  to  describe 
some  of  these  different  forms  of  indigestion  and  to  out- 
line, briefly,  the  treatment  I  employ  for  each. 
Colic  from  Overeating 

First  consider  engorgement  of  the  stomach.  Not 
that  I  really  consider  it  acute  indigestion,  for  it  is  not ;  yet 
in  so  many  of  these  cases  the  symptoms  approximate 
those  of  acute  indigestion  and  the  treatments  are  so 
nearly  the  same  that  I  think  it  may  well  be  described 
with  this  class. 

To  illustrated  this  similarity,  take  a  typical  case  of 
recent  occurrence  in  my  own  practice.  A  small,  black 
horse,  aged  eighteen  years;  a  very  fat,  well-preserved 
animal,  and  a  good  individual,  even  at  this  age,  and  ap- 
parently well  cared  for,  was  brought  to  me  for  treatment. 

The  evening  preceding  this  attack  he  had  been  taken 
out  for  a  drive,  and  afterwards  put  away  as  usual,  about 
10  p.  m.  The  next  morning  he  was  found  down  in  the 
stall,  rolling  from  side  to  side,  and  very  badly  bloated. 


♦Reprinted  from  the  April,   1913,  issue  of  the  American  Journal  of  Vet- 
erinary Medicine. 


38  COLICS  AND  THEIR  TREATMENT 

The  owner  immediately  started  for  the  hospital  with  him, 
and  a  call  was  sent  in  for  me  to  meet  him  there,  as  he 
was  bringing  me  a  very  sick  horse. 

Symptoms. — On  my  arrival  at  the  hospital  I  noted 
the  following  symptoms :  a  very  anxious  look  from 
the  eyes,  breathing  very  labored,  each  inspiration  accom- 
panied by  a  jerk,  and  the  abdomen  bloated  to  about  twice 
its  normal  size.  As  soon  as  he  was  permitted  to  stop  he 
would  lie  down  and  roll ;  an  act  difficult  to  accomplish 
on  account  of  the  badly  distended  abdomen.  He  could 
not  remain  down  long,  but  would  get  to  his  feet  again 
and  then  lower  his  head  close  to  the  ground  with  his  legs 
drawn  under  him,  and  in  this  position  would  turn  in  a 
small  ring,  a  time  or  two,  and  then  drop  to  the  ground. 
This  performance  was  kept  up  until  I  had  my  stomach 
tube  prepared  for  use  and  was  ready  to  take  care  of  the 
case. 

Course  and  Treatment. — First  the  horse  was  put 
into  a  chute,  securely  tied,  and  the  stomach  tube  passed, 
not  without  some  trouble  because  of  the  great  uneasiness 
of  the  animal.  By  the  use  of  plenty  of  water  I  succeeded 
in  washing  out  of  the  stomach  about  two  gallons  of  solid 
feed.  This  required  about  fifteen  minutes.  The  tube 
was  removed  and  the  horse  put  into  a  box  stall. 

Distention  of  the  colon  being  very  bad,  I  gave  a  hypo- 
dermic injection  of  eserine,  one-half  grain,  pilocarpine, 
one  and  one-half  grains.  Following  there  was  great  un- 
easiness, violent  rolling,  but  rarely  turning  over;  the  head 
was  frequently  turned  to  the  right  side.  Very  little  per- 
istalsis could  be   detected.     Following  the  injection   of 


STOMACH  LAVAGE  39 

eserine  and  pilocarpine,  there  was  profuse  salivation,  but 
no  gas  or  fecal  matter  was  expelled. 

At  7  a.  m.  the  stomach  tube  was  passed  a  second 
time.  About  one-half  gallon  of  solid  food  was  removed 
this  time,  and  the  fluid  that  came  with  it  was  very  sour 
and  of  an  offensive  odor.  Cold  water  rectal  injections 
were  given.  The  water  came  away  barely  colored,  no 
defecation  followed. 

Arecoline,  one  grain,  and  strychnine,  one-half  grain, 
was  then  given.  This  occasioned  great  distress,  a  very 
fast,  weak  pulse,  very  labored  breathing  and  profuse  sali- 
vation. After  an  hour  he  became  somewhat  easier  and 
lay  quiet,  rolling  only  at  intervals,  with  a  very  distress- 
ing look  from  the  eyes  and  the  nostrils  wide  open.  The 
injection  of  arecoline  and  strychnine  induced  no  flatus  or 
fecal  passage.  Cold  water  enema  was  given  and  the  clear 
water  expelled. 

At  10  a.  m.  the  tube  was  passed  again.  No  solids 
whatever  were  removed  this  time,  but  quite  an  abund- 
ance of  sour  fluid  came  away.  After  washing  the  stom- 
ach until  the  water  returned  clear,  one  and  one-half  pints 
of  raw  linseed  oil  and  one  and  one-half  ounces  of  tur- 
pentine were  given  through  the  stomach  tube,  and  this 
was  followed  by  a  rectal  injection  of  cold  water,  after 
which  the  horse  became  easier. 

At  1  p.  m.  one-half  grain  of  strychnine  was  given; 
the  bloating  had  noticeably  diminished,  but  was  still  in 
evidence.  At  3  p.  m.  the  bloating  was  gone  and  the  pa- 
tient was  standing  easier  and  looked  bright  out  of  eyes. 
Very  little  peristalsis  could  be  detected  in  any  part  of 
the  intestinal  tract ;  no  defecation  as  yet. 


40  COLICS  AND  THEIR  TREATMENT 

At  5  :30  p.  m.  he  wanted  to  eat  when  the  other  horses 
were  fed,  a  small  handful  of  hay  was  given  him  and  he 
ate  it  greedily.  At  6  p.  m.  ninety  grains  of  sulphocar- 
bolates  compound  and  one  grain  of  strychnine  was  given 
in  a  capsule. 

Nothing  further  was  given  this  patient  and  there 
was  no  passage  from  the  bowels  for  forty-eight  hours; 
when  a  small  quantity  of  feces  was  voided,  very  heavily 
coated  with  coagulated  albumen,  in  fact,  entirely  covered 
with  it.    A  nice  recovery  followed  without  complications. 

Resume. — I  cite  this  case  because  of  its  train 
of  symptoms,  first  badly  bloated,  second,  amount  of  solids 
removed  by  the  use  of  the  tube,  and,  next,  no  action  of 
the  bowels  from  beginning  to  end.  Not  a  single  passage 
from  them  in  forty-eight  hours,  nor  any  gas  to  speak  of, 
yet  the  bloating  was  relieved  by  persistently  and  repeat- 
edly using  the  stomach  tube,  and  a  nice  recovery  fol- 
lowed. 

While  I  had  a  very  satisfactory  recovery  in  this  case 
and  in  many  others  similar  to  it ;  for  the  medicinal  treat- 
ment in  such  cases  I  have  since  quit  using  eserine  and 
arecoline.  Instead  I  use  pilocarpine  in  two-grain  doses, 
as  the  case  seems  to  demand.  There  is  no  doubt  that  the 
use  of  either  physostigmine,  or  arecoline,  or  barium 
chloride  are  contraindicated  here,  as  these  agents  produce 
more  trouble  by  their  action  on  the  muscles  of  bowels 
than  they  do  good.  Oils  or  oil  and  turpentine  is  much 
better;  notwithstanding  their  slower  action,  they  are  far 
surer.  The  addition  of  four  to  eight  ounces  of  ether  to 
the  oil  is  very  advantageous. 


STOMACH  LAVAGE  41 

Colic  from  Acute  Gastritis 

There  is  another  form  of  indigestion,  one  which  is 
met  with  very  often,  and  one  we  all  agree  should  be 
termed  acute  indigestion.  It  occurs  when  the  horse  is 
fed  early  before  the  usual  hour  and  started  as  soon  as 
he  has  eaten  on  a  long  drive,  of  say  from  twenty  to  forty 
miles. 

Symptoms. — These  cases  begin  with  purging  out, 
after  being  driven  from  seven  to  fifteen  miles.  As  the 
animal  is  forced  onward  he  shows  little  or  no  inconven- 
ience while  moving,  or  he  may  slack  up  in  his  gait,  but 
not  enough  to  be  called  really  sick,  but  every  half  to  one 
mile  he  will  have  a  movement  of  the  bowels,  and  at  each 
time  the  discharge  grows  more  watery  or  fluid.  This  will 
continue  for  several  miles,  when  gradually  it  will  cease 
and  apparently  he  is  over  his  trouble. 

The  difficulty,  however,  is  not  over,  for  when  un- 
hitched and  led  to  water  he  will  walk  with  his  head  down 
and  with  a  slow,  shambling  gait.  He  refuses  to  drink  or 
eat ;  stands  resting  on  one  or  the  other  of  the  hind  feet ; 
head  hanging  down ;  at  intervals  the  head  will  be  raised 
and  the  nose  pointed  outwards.  As  soon  as  these  move- 
ments are  gone  through  with  the  head  will  be  drooped 
again  and  a  change  of  position  of  the  hind  legs  will  take 
place,  shifting  from  one  to  the  other. 

Soon  he  will  paw  a  little  with  one  front  foot  and  then 
with  the  other;  instead  of  raising  and  lowering  the  head, 
he  will  now  look  around  towards  his  sides  and  you  will 
note  that  the  nostrils  are  more  widely  open  than  normal 
and  the  breathing  is  just  a  trifle  faster  than  it  should  be. 

As  time  goes  on  he  will  get  more  uneasy  and  threaten 


42  COLICS  AND  THEIR  TREATMENT 

to  lie  down  by  getting  down  on  his  knees,  then  getting  up 
again.  These  symptoms  usually  last  about  an  hour  in 
such  cases. 

When,  as  the  trouble  advances,  the  symptoms  in- 
crease in  severity,  the  horse  will  not  only  lie  down  but  let 
himself  fall  with  a  thud.  And  thus  the  case  becomes  very 
critical.  At  this  time,  by  carefully  listening  along  the 
course  of  the  esophagus,  one  may  hear  distinctly  the  fluid- 
like rumble  of  regurgitation  from  the  stomach. 

Usually  considerable  gas  is  expelled  per  anum  and 
to  this  alone  is  due  the  fact  that  the  animal  does  not  be- 
come badly  bloated.  Should  the  flatus  fail  to  escape, 
then,  of  course,  there  is  distention  of  the  colon,  which 
adds  to  the  other  trouble. 

Treatment. — In  these  cases  the  treatment  indicated 
is  similar  to  the  treatment  for  the  indigestion  from  over- 
loading. Confine  the  horse  securely  and  pass  the  stom- 
ach tube. 

The  results  are  so  striking  in  this  class  of  cases  that 
one  must  stop  and  wonder  how  it  is  accomplished.  The 
bloody  looking  fluid,  that  comes  away  from  one  of  them 
and  the  relief  that  is  given  almost  at  once,  surprises  one 
who  has  not  previously  seen  it.  The  amount  washed  from 
the  stomach  varies  greatly,  from  an  ordinary  pailful  in 
some  of  them,  to  three  or  four  times  as  much  in  others. 

It  is  very  seldom  that  any  solids  to  speak  of  can  be 
washed  from  the  stomach  in  these  cases,  but  the  fluid 
that  comes  out  of  it  is  very  offensive  and  dark  colored, 
often  almost  like  blood. 

If,  when  washing  out  this  stomach,  one  will  keep  at 
it  until  the  water  comes  away  almost  clear,  he  will  have 


STOMACH  LAVAGE  43 

very  little  else  to  do.  No  medicinal  treatment  is  needed 
unless  it  be  a  small  dose  of  strychnine,  one-quarter  grain, 
as  a  heart  stimulant. 

Convalescence. — Should  the  horse  become  un- 
easy, an  hour  or  two  later  pass  the  tube  again.  Such 
relapses  are  due  to  a  retrograde  peristalsis,  that  again 
fills  the  stomach ;  pass  the  stomach  tube  and  a  return  of 
fluid  through  it  will  result.  The  fluids  at  this  time  will 
be  colored,  but  not  nearly  so  much  as  at  the  time  of  first 
using  the  tube. 

It  is  rarely  the  case  that  the  animal  will  need  an- 
other thing  after  using  the  stomach  tube  in  this  class. 
After  using  the  tube  until  the  stomach  no  longer  fills  by 
antiperistalsis,  these  patients  will  stand  around  drowsy 
from  one  to  two  hours,  as  though  partially  asleep,  then 
will  want  to  eat.  I  usually  let  them  have  some  good 
prairie  hay,  no  alfalfa,  and  so  far  have  had  no  bad  re- 
sults from  it.  Keep  the  grain  away  for  about  thirty- 
six  hours,  after  which  it  is  not  likely  to  be  harmful. 

Resume. — To  go  back  again — if  when  called 
to  this  class  of  cases  the  symptoms  have  gone  far  enough, 
there  will  be  belching  of  gas,  and  very  frequently  fluids 
will  be  returned  through  the  nose.  While  this  is  not 
what  one  would  wish  to  see  in  any  of  these  cases,  I 
had  always  rather  see  this  than  to  be  told  my  patient 
has  just  lately  become  easier,  and  they  think  he  is  doing 
all  right,  for  in  almost  all  of  such  cases  that  have  gone 
through  this  train  of  symptoms  and  have  become  easy, 
you  will  find  that  a  nervous  shock  has  set  in.  The  animal 
is  trembling  in  certain  groups  of  muscles,  usually  the 
shoulders  and  flanks,  a  sweat  has  broken  out  that  has  a 


44  COLICS  AND  THEIR  TREATMENT 

cold  feel  to  it,  even  on  a  warm  day.  These  are  the  cases 
in  which  you  should  not  pass  a  stomach  tube,  for,  I  as- 
sure you,  you  will  be  blamed  for  tearing  that  horse's 
stomach  with  the  tube  if  you  do  pass  it  here. 

This  tearing  of  the  stomach  is,  of  course,  a  thing 
quite  impossible  with  a  double  tube,  yet  you  will  be 
blamed  for  the  rupture,  which  is  already  present  when 
the  tube  is  passed. 

The  foregoing  symptoms  obtain,  with  a  very  few 
exceptions,  only  in  ruptures,  not  always  of  the  stomach, 
but  of  any  part  of  the  intestines  and  of  the  diaphragm 
as  well.  But  the  cold  sweat  is  almost  a  conclusive  evi- 
dence of  rupture  of  the  stomach,  and  a  stomach  tube 
should  never  be  passed  on  one  of  them.  So  long  as  you 
are  in  time  to  see  these  cases  belching  gas  and  fluids  from 
the  nose  (vomiting),  you  can  be  sure  that  you  have  a 
stomach  that  is  full  and  not  ruptured.  For  once  rupture 
of  the  stomach  occurs  no  more  fluid  returns. 

I  had  been  told  time  after  time  that  when  a  horse 
was  seen  to  vomit  that  the  stomach  had  ruptured.  This 
is  unbelievable;  how  could  vomition  be  accomplished 
after  rupture  has  taken  place  ?  The  contents  of  the  stom- 
ach would  empty  through  the  rent  in  it.  There  could  be 
no  muscular  contractions  to  produce  vomiting  and  so 
no  horse  ever  vomited  after  a  rupture  of  the  stomach  had 
occurred.  As  long  as  you  can  be  sure  of  this,  you 
should  not  wait,  or  hesitate  to  pass  the  tube.  Don't  con- 
sult the  owner  as  to  the  work.  He  does  not  know,  and 
for  this  reason  would  likely  object,  for  it  would  be  new 
to  him.  Get  ready  and  do  it.  And  while  at  it  keep  on 
until  you  do  get  the  results.    Don't  quit  and  have  to  say 


STOMACH  LAVAGE  45 

you  were  wrong,  for  if  you  have  taken  time  to  examine 
the  case  you  can't  go  amiss,  and  then  the  owner  will  be 
the  next  one  to  comment  on  the  use  of  the  stomach  tube 
and  you  will  get  the  benefit. 

At  this  point  I  would  like  to  emphasize  that  so  far 
as  the  fluids  returning  of  their  own  accord,  or  rather 
from  the  distension  of  the  stomach,  I  always  think  is  a 
good  symptom,  for  had  this  not  occurred  I  am  sure  that 
I  should  have  been  too  late  in  many  cases,  for  the  ac- 
cumulation of  fluids  in  them  occurs  very  rapidly,  and 
many  cases  after  two  or  three  hours  are  filled  and  rup- 
ture, and  invariably  in  them  the  owner  will  tell  you  his 
horse  is  lots  better  and  has  got  so  he  will  stand  on  his 
feet,  something  he  would  not  do  until  just  lately.  Do  not 
let  such  talk  deceive  you,  but  look  carefully  and  note  if 
you  have  any  trembling  of  the  muscles,  etc. 

I  do  not  wish  to  impart  the  idea  that  all  of  this  class 
of  cases  of  acute  indigestion  terminate  fatally,  unless  a 
stomach  tube  is  used,  for  such  is  not  the  case.  I  have 
seen  a  great  many  live,  but  on  the  other  hand  I  formerly 
had  many  a  one  taken  away  dead,  and  others  have  had 
the  same  experience.  But  since  using  the  tube,  I  do  not 
have  this  loss,  nor  will  any  one  else  who  will  follow  this 
line  of  treatment. 

Colic  from  Exhaustion 

This  form  of  acute  indigestion  is  often  met  with  in 
the  heavier  horses  at  hard  work,  not  necessarily  fast 
work,  but  hard  pulling,  such  as  draying,  excavating 
work,  coal,  lumber  and  brick  hauling,  etc. 

Cause.— Take  it  on  a  warm,  sultry  day:  the  teams 
are   usually   fed    early   in    the   morning   and    started 


46  COLICS  AND  THEIR  TREATMENT 

to  work  at  7  or  8  a.  m. ;  from  that  time  on  till  noon  they 
are  kept  going.  At  noon  the  team  is  either  fed  in  nose 
bags  or  one  box  suffices  for  both  horses.  At  this  time 
the  driver  will  notice  that  one  horse  is  not  eating;  the 
chances  are  he  has  not  drunk  any  water,  but  this  was 
not  noted.    No  hay,  or  but  a  very  small  amount,  is  given. 

Symptoms. — At  1  p.  m.  they  are  again  hooked 
up  and  put  to  work,  the  horse  goes  fairly  well  until 
about  2  :30,  when  he  becomes  slow,  does  not  want  to 
keep  up  his  end  of  the  load;  on  being  struck  with  the 
whip  he  will  spurt  up  for  a  short  distance,  but  soon  is 
lagging  back  again.  As  soon  as  allowed  to  stop  he  will 
look  around  at  his  side,  likely  paw  a  little  with  one  foot ; 
if  pressed  onward  he  will  shortly  get  to  wanting  to  lie 
down  in  the  harness,  and  will  do  so  as  soon  as  allowed 
to  stop. 

About  this  time  it  is  noticed  that  the  horse  is  com- 
mencing to  breathe  hard,  and  that  he  is  also  starting  to 
bloat.  Now  is  the  time  when  everyone  around  will  sug- 
gest that  horse  be  given  a  dose  of  nitre  for  his  kidneys. 
The  driver  will  just  have  remembered  he  has  not  urinated 
during  the  entire  day.  This,  from  their  viewpoint,  is 
positive  proof  that  the  horse  is  bothered  with  a  "stoppage 
of  the  kidneys."  A  dose  (sweet  spirits  of  nitre)  is  pre- 
pared in  size  varying  from  fifteen  drops  to  three  ounces. 

After  a  time  they  notice  he  is  growing  worse  on  the 
nitre.  You  are  called.  This  is  seldom  done  until  the 
horse  is  very  far  along.  You  will  find  him  wet  with  per- 
spiration and  usually  a  mass  of  mud,  rolling  from  side 
to  side,  pulse  weak  and  fast,  breathing  very  labored,  and 
with  a  very  anxious  look  from  the  eyes. 


STOMACH  LAVAGE  47 

On  raising  he  won't  want  to  straighten  up  in  a  nor- 
mal position,  but  will  crouch  clown,  with  his  legs  well 
under  him.  Many  will  let  themselves  drop ;  if  so  they 
always  emit  a  heavy  grunt  following.  Most  of  them  are 
more  careful  and  will  make  several  efforts  to  lie  down 
before  doing  so. 

They  roll  violently  for  a  short  time,  but  soon  get 
up.  Breathing  becomes  harder  and  shorter  right  along, 
and  if  relief  is  not  soon  given,  the  animal  is  speedily  be- 
yond help.  The  bloating  and  also  the  severity  of  the 
pain,  of  course,  can  be  temporarily  relieved  by  the  trocar, 
an  instrument  I  very  seldom  use. 

Treatment. — In  these  cases  confine  the  animals 
securely  as  directed  before,  for  they  are  very  uneasy 
from  the  distended  stomach  and  intestines.  It's  an  ex- 
ception when  I  tap  an  animal,  but  it  is  sometimes  neces- 
sary. I  rely  almost  altogether  on  the  use  of  the  stomach 
tube.  In  eight  out  of  every  ten  cases  as  soon  as  I  get 
the  return  of  the  fluids  and  solids  from  the  stomach 
started  the  patient  will  become  easy  and  many  will  not 
move  until  the  tube  is  ready  to  be  withdrawn. 

In  these  cases  you  may  look  for  from  two  quarts 
to  three  gallons  of  mixed  feed,  according  to  what  is  fed. 
In  our  town  it  is  usually  cracked  corn  and  bran,  some- 
times shorts  instead,  rarely  oats.  It  is  not  an  uncom- 
mon thing  to  get  four  gallons  of  solid  corn  and  bran 
from  the  operating  room  floor  after  I  have  finished,  this 
in  addition  to  a  certain  amount  which  drains  into  the 
sewer  with  the  fluids. 

I  am  sure  that  to  get  results  in  these  cases  one  must 
have  a  double  stomach  tube,  because  the  feed  is  sour  and 


48  COLICS  AND  THEIR  TREATMENT 

heavy  and  would  choke  up  any  single  tube  used.  It  will 
in  some  cases  choke  up  a  double  tube,  but  there  is  this 
advantage,  water  is  forced  into  this  mass  continually, 
thinning  it  up  all  the  while,  and  not  only  that,  enough 
air  is  being  forced  into  the  stomach  to  let  it  have  an  air 
space,  without  which  siphoning  is  not  successful.  I  will 
admit  that  in  pumping  water  into  the  stomach  increased 
pressure,  to  a  greater  or  less  extent  is  produced,  just 
how  much  I  do  not  know,  but  from  actual  experience  I 
do  know  that  not  enough  can  be  caused  to  do  a  good  job 
of  lavage  with  the  single  tube. 

In  this  class  of  colic  should  your  horse  not  ease  off 
in  forty-five  minutes,  use  the  tube  again.  At  this  time 
the  gas  will  practically  all  come  away  and  you  do  not 
run  any  risk  of  causing  any  trouble  from  the  puncture, 
from  dirt,  etc.,  as  when  using  the  trocar. 

It  is  not  often  that  cases  such  as  this  will  need  any 
medicine,  yet  I  think  that  an  antiseptic,  such  as  eucam- 
phine  eucalyptolin  or  sulphocarbolates  compound  is  ben- 
eficial, and  sometimes  strychnine  as  a  stimulant  aids  ma- 
terially; yet  there  are  few  that  really  need  them. 

The  case  described  in  the  foregoing  is  one  of  many 
of  its  kind  that  occur  here  in  Topeka,  and  I  am  sure  that 
my  success  with  them  is  entirely  due  to  the  persistent 
use  of  the  stomach  tube ;  for  ten  years  ago  and  longer,  I 
can  remember  of  many  good  horses  being  hauled  out  to 
the  desiccating  plant  from  attacks  of  this  type. 

I  would  like  to  impress  upon  the  minds  of  all,  that 
in  all  cases  like  the  foregoing,  if  it  is  possible  to  get 
them  to  the  hospital  where  you  can  use  city  water  pres- 
sure for  the  gastric  lavage,  to  do  so.    Better  results  will 


STOMACH  LAVAGE  49 

thus  be  had  than  it  is  possible  to  have  in  any  other  way. 
No  pump  can  take  the  place  of  city  pressure.  It  is  al- 
ways the  same  and  always  at  hand.  Should  they  be  too 
bad  to  come  to  the  hospital,  use  the  tube  first,  and  get 
away  all  that  you  can  with  the  pump.  This  will  relieve 
them  enough  so  that  they  may  be  taken  to  the  hospital  if 
you  keep  them  moving.  As  soon  as  you  arrive  at  the  hos- 
pital pass  the  tube  again,  this  time  using  plenty  of  time 
and  water  and  remove  all  sour  material,  in  other  words, 
keep  the  stream  of  water  going  in  until  the  water  comes 
out  clear  and  cool. 

The  class  of  cases  just  described  are  typical  cases, 
in  which  a  tube  should  be  used,  and  that  at  once.  Do 
not  try  any  form  of  medicinal  treatment  first,  for  any 
form  of  drench  only  fills  up  the  already  distended  stom- 
ach and  arecoline  or  eserine  and  pilocarpine,  hypoder- 
mically,  surely  aggravates  all  the  symptoms  and  causes 
the  animal  to  thrash  around  a  great  deal  more  than  he 
would  without  them ;  and  not  only  that,  but  in  his  agony 
he  is  likely  to  let  himself  fall  hard  enough  to  rupture  the 
stomach,  in  its  distended  state. 

Colic  Due  to  Enfeebled  Digestion 

There  is  another  common  type  of  colic;  while  it  may 
not  be  considered  acute,  it  is  none  the  less  indigestion, 
and  is  very  amenable  to  treatment  with  the  stomach  tube. 

Symptoms. — The  animal  will  first  show  a  slug- 
gish disposition,  head  hanging  downward,  resting  on 
three  feet,  restless  at  intervals.  Such  as  stated  will  take 
a  few  mouthfuls  of  hay  and  eat  it,  not  with  a  relish,  but 
chewing  it  slowly,  if  in  a  tie  stall,  it  will  paw  at  inter- 


50  COLICS  AND  THEIR  TREATMENT 

vals,  then  for  a  time  will  be  quiet  and  apparently  half 
asleep. 

This  may  continue  for  as  much  as  half  a  day  before 
anything  is  thought  of  it.  The  owner,  when  calling,  will 
give  you  to  understand  that  while  he  would  like  to  have 
you  come  and  see  his  horse,  he  does  not  consider  that 
there  is  much  the  matter  with  him,  but  thinks  probably 
a  dose  of  nitre  or  something  of  this  nature  would  fix  him 
all  right.  He  has  already  diagnosed  the  case  and  stipu- 
lated what  to  give. 

On  the  veterinarian's  arrival  these  patients  are  usu- 
ally quiet  and  it  is  quite  a  difficult  thing  to  convince  the 
man  that  he  might  be  mistaken,  both  in  diagnosis  and 
treatment.  He  will  be  sure  to  have  noticed  that  the  horse 
has  been  trying  hard  to  pass  urine.  This  in  a  measure 
cannot  be  held  against  the  man,  for  in  nine  out  of  every 
ten  of  these  cases,  the  animal  will  at  times  stretch  out, 
placing  the  front  feet  as  far  forward  as  he  can.  This, 
to  a  degree,  relieves  the  pain  of  the  animal,  but  the  owner 
cannot  be  made  to  believe  this  (at  least  many  of  them 
will  not),  and  while  you  can  repeatedly  tell  him  differ- 
ently he  will  continue  to  think  he  is  right,  and  should  he 
induce  the  animal  to  urinate,  no  matter  how  long  after- 
wards it  is,  before  the  animal  is  over  his  trouble,  the 
owner  will  think  his  position  proven  to  be  the  correct  one. 

By  the  time  you  are  called  the  patient  will  have  been 
sick  from  five  to  ten  or  twelve  hours.  At  this  time  the 
condition  has  changed;  the  slow  gripping  pains  have 
given  place  to  pains  more  acute,  and  the  patient  is  more 
restless.  If  in  a  box  stall  he  will  be  in  one  corner  usually, 
pawing;  at  intervals  he  will  toss  his  head  up  and  down, 


STOMACH  LAVAGE  51 

then  apparently  be  easy  for  a  spell.  He  will  stand 
quietly  for  a  short  time,  but  very  soon  he  will  raise  the 
head,  nose  pointed  out,  will  turn  up  the  upper  lip;  this 
will  be  quite  noticeable.  Respiration  is  somewhat  hur- 
ried, but  not  labored  in  any  way.  Temperature  about 
normal  to  one  degree  of  elevation.  No  flatulence  to  speak 
of  may  be  noticeable  as  yet.  He  does  not  show  any  great 
distress  at  any  time,  and  while  lying  down  is  quiet;  he 
does  not  tumble  from  side  to  side,  but  will  point  the  nose 
out  and  turn  the  upper  lip  up,  showing  the  incisor  teeth. 

Treatment. — With  this,  as  with  other  cases,  I 
always  pass  the  stomach  tube  and  invariably  get  some 
gas  and  quite  a  lot  of  sour  feed  from  the  stomach.  If 
the  stomach  is  washed  clean  of  this  sour  mass  and  fluids, 
it  will  be  but  a  short  time  until  the  animal  will  quit  turn- 
ing up  the  lip  and  soon  all  uneasiness  will  have  passed. 

Why  use  medicine  in  these  cases  when  a  stomach 
tube,  rightly  used,  will  relieve  your  patient  so  promptly  ? 
I  do  not  mean  to  be  understood  that  in  such  cases  a  tube 
must  necessarily  be  used  in  order  to  have  a  recovery,  for 
I  know  it  is  not  really  essential.  I  am  aware  that  me- 
dicinal treatment  in  this  class  of  cases  is  almost  always 
successful  in  time,  but  it  does  take  time  for  the  medicine 
to  act  and  still  more  time  for  the  intestinal  tract  to  rid 
itself  of  the  sour  mass. 

In  all  our  work  we  strive  to  remove  the  cause,  then 
why  not  in  these  cases  I  have  mentioned.  If  we  can  do 
this  why  are  we  not  getting  at  the  seat  of  the  trouble.  1 
am  positive  that  in  eight  out  of  every  ten  cases  of  this 
type  the  trouble  starts  right  in  the  stomach,  and  that  as 
time  goes  on,  and  fermentation  takes  place,  this  same 
stomach  acts  as  a  generator  of  gas.  and  since  the  stomach 


52  COLICS  AND  THEIR  TREATMENT 

of  the  horse  is  so  well  guarded  as  to  almost  exclude 
vomition,  we  can  readily  see  that  unless  it  does  pass  along 
the  intestinal  tract  we  soon  will  have  a  largely  distended 
stomach  to  contend  with. 

On  the  other  hand,  should  it  follow  the  intestinal  tract 
and  accumulate  in  the  cecum  and  large  colon,  we  have  a 
badly  bloated  animal.  I  will  admit  that  this  gas  can  be 
removed  readily  by  using  the  trocar  and  canula,  but  will 
this  be  all?  I  have  tapped  horses  as  many  as  eight  or 
nine  times  in  one  night  to  keep  them  from  smothering, 
but  too  many  of  them  died  to  suit  me,  and  why  ?  Because 
I  did  not  remove  the  generator  of  the  gas — the  cause  of 
the  colic.  Then  why  not  use  a  stomach  tube  (one  that 
will  do  the  work)  in  this  case,  and  remove  all  this  trouble 
from  where  it  starts.  This  done,  you  have  no  more  ac- 
cumulation of  gas.  You  have  spent  only  from  five  to 
twenty  minutes  of  your  time,  you  have  no  use  for  the 
trocar,  your  patient  rests  easily  and  you  are  sure  you  can 
go  home  to  rest  or  answer  calls,  knowing  that  things 
will  be  all  right. 

I  have  made  no  mention  of  the  different  colics  of  the 
horse,  nor  to  the  differential  diagnosis  of  them,  in  this 
article,  for  I  am  sure  if  you  will  read  Dr.  R.  P.  Lyman's 
article  (in  the  May,  1912,  issue  of  Veterinary  Med- 
icine), you  will  have  to  say  it  is  the  best  article  on  the 
diagnosis  of  colics  of  the  horse  ever  published. 


Surgical  Treatment    of   Colics  in  Horses* 

L.  A.  Merillat,  V.  S.,  Chicago,  111. 

PROFESSOR   OF    SURGERY,    M'KILLIP   VETERINARY    COLLEGE 

I  am  using  this  title,  for  want  of  a  better  one,  to  pre- 
sent a  brief  review  of  the  available  forms  of  instrumen- 
tation useful  in  the  management  of  gastric  and  intestinal 
obstructions  of  animals,  and  I  trust  you  will  not  be  de- 
ceived by  the  startling  title — "The  surgical  treatment  of 
colics,"  which  might  easily  be  mistaken  for  more  than 
I  shall  be  able  to  disclose  as  rational  treatment  of  a  sur- 
gical character  for  intestinal  and  gastric  ailments.  Let 
me  therefore  first  announce  that  this  epitome  is  not  a 
startling  proclamation  about  the  invasion  of  the  intestinal 
tract  through  the  abdominal  wall.  On  the  contrary, 
as  Prof.  Hobday  has  stated,  and  as  Doctor  Blattenburg 
has  reaffirmed,  I  shall  repeat,  that  we  are  not  today  and 
probably  never  shall  be  able  to  invade  the  abdominal 
viscera  to  any  great  extent. 

One  of  my  objects  is  to  draw  attention  to  the  necessity 
of  diagnosing  abdominal  disease  at  an  early  stage  with 
more  certainty  in  order  that  we  may  attack  them  with  a 
therapy  directed  precisely  at  the  affected  part.  Colic,  I 
dare  say,  in  veterinary  practice  is  too  frequently  treated 
as  such.  I  have  often  thought  if  the  word  colic  had 
never  entered  our  nosology  we  would  then  have  ap- 
proached abdominal  pain  with  more  searching  inquiry  as 


•Published  in  the  January,    1914,   issue   of  the  American  Journal  of   Vet- 
erinary Medicine. 


54  COLICS  AND  THEIR  TREATMENT 

to  the  nature  of  causative  condition  and  then  all  of  these 
years  we  should  have  been  treating  causes  instead  of 
eternally  seeking  medicament  to  cure  the  effect. 

Colic  in  animals  has  usually  been  considered  as  a  mild, 
or  overwhelming  abdominal  pain,  as  the  case  may  be,  and 
too  little  attention  has  been  paid  to  the  underlying  cause. 
Our  weakest  point  in  the  management  of  colics  is  our 
inability  to  diagnose  the  cause  of,  and  the  seat  of  the 
ailment,  at  a  stage  early  enough  to  put  direct,  effectual 
treatment  into  operation  before  it  is  too  late. 

The  conventional  treatment  of  almost  all  colics  is  the 
administration  of  a  pain-relieving  potion,  and  then,  if 
this  is  not  followed  by  a  cessation  of  the  pain,  an  evacu- 
ant  is  thought  necessary.  When  these  two  fail  the 
patient  dies.  The  painkillers  are  usually  morphine,  can- 
nabis indica  or  chloral  and  the  evacuant  anything  from 
a  hypodermic  injection  of  violent  eserine,  arecoline  or 
pilocarpine  to  a  large  drench  of  linseed  or  castor  oil. 

In  addition  to  the  foregoing,  when  there  is  bloating, 
carminatives  and  antiferments  are  given  and  if  the  bloat 
is  threatening  a  trocar  and  canula  are  thrust  into  the 
right  flank.  This,  with  a  few  variations  in  the  selection 
of  drugs,  constitutes,  with  most  of  us,  the  standard 
treatment  of  colics  today,  and  these  treatments  are  so 
strictly  conventional  that  almost  anyone  of  ordinary  in- 
telligence can  master  the  entire  system  after  a  few  days 
of  instruction.  In  fact,  we  all  know  of  "handy"  fellows 
in  veterinary  hospitals  and  large  stables  who  manage 
colics  quite  up  to  the  prevailing  standards. 

This  is  not  as  it  should  be  in  this  day  of  sane  thera- 
peutics.    We  should  accept  now  the  burden  of  studying 


SURGICAL  TREATMENT  OF  COLICS  55 

observations  on  our  patients,  sick  from  abdominal  dis- 
eases, with  a  view  of  determining  the  exact  nature  of 
the  condition  responsible  for  the  pain. 

Autopsy  after  autopsy  held  on  animals  dead  from  col- 
ics shows,  too  often,  how  wide  of  the  mark  our  treat- 
ment had  been  and  how  useless  were  our  efforts  to  turn 
the  tide  toward  a  recovery  if  we  did  succeed  at  a  late 
stage  to  discover  the  cause.  Very  often  these  post- 
mortem investigations  show  that  a  vigorous  attack  at 
the  affected  spot  right  from  the  beginning  might  have 
been  effective. 

By  exclusion,  we  do  sometimes,  after  a  patient  has 
suffered  for  some  time,  make  a  correct  diagnosis  but 
then  it  is  usually  too  late  to  effect  a  cure.  In  short,  such 
cases  are  already  beyond  hope  and  out  of  reach  of  any 
treatment  when  the  diagnosis  is  made. 

The  better  management  of  abdominal  diseases  must 
come  through  an  intensive  study  of  symptoms  and  groups 
of  symptoms  coupled  with  probable  causes  which  will  en- 
able us  to  determine  early  in  the  march  of  the  disease 
the  exact  seat  and  the  exact  nature  of  the  trouble. 
Abdominal  Pains  Misleading 

Abdominal  pains,  to  say  the  least,  are  very  misleading. 
Even  in  human  beings,  where  the  symptoms  are  sub- 
jective, grave  errors  are  often  made  by  the  treachery  of 
pain.  For  example  a  patient  with  an  attack  of  appen- 
dicitis may  complain  of  pain  in  the  left  loin  or  over  the 
solar  plexus.  The  location  of  pain,  in  fact,  gives  no  as- 
surance that  the  lesion  is  at  the  same  point.  So  mis- 
leading are  these  expressed  manifestations  that  only  the 
specialist  seems  able  to  properly  interpret  them. 


56  COLICS  AND  THEIR  TREATMENT 

In  animal  patients  we  may  actually  be  thankful  to  be 
rid  of  this  group  of  subjective  symptoms.  In  truth  we 
are  at  no  loss  whatever  in  diagnosing  the  seat  of  ab- 
dominal pain  for  want  of  them.  I  am  certain  after  many 
observations  covering  a  good  many  years  amongst  ani- 
mals sick  with  colics  that  the  objective  symptoms  pre- 
sented by  animals  if  properly  studied  and  if  properly 
grouped  and  then  coupled  with  the  probable  cause  can  be 
depended  upon  as  fairly  diagnostic  of  special  conditions 
even  in  the  early  stages  of  painful  abdominal  diseases. 
And  it  is  largely  in  this  direction  we  must  turn  our  at- 
tention if  we  would  arrive  at  that  "refinement  of  diag- 
nosis" upon  which  all  sound  treatment  must  be  based. 

In  short  we  are  now  face  to  face  with  the  problem  of 
differentiating  as  to  exact  location  and  cause  of  pain  in 
the  alimentary  canal  within  the  abdomen.  Pain  in  the 
stomach  should  be  differentiated  from  pain  in  the  colon, 
and  either  should  be  distinguished  from  pain  in  the  small 
bowels,  and  so  on,  at  a  very  early  stage  of  the  colic. 
With  these  difficulties  out  of  the  way  the  treatment  of 
colics  would  at  once  be  simplified  into  a  more  effectual 
attack  upon  the  actual  trouble.  And  while  I  admit  that 
perfection  in  making  these  differentiations  need  not  be 
expected  it  is  only  by  developing  a  more  inquisitive  dis- 
position toward  these  phenomena  that  we  may  ever  hope 
to  become  sufficiently  proficient  to  bring  our  treatment 
of  intestinal  obstruction  up  to  a  worthy  standard  of 
excellence. 

Inspection  and  Palpation 

In  addition  to  the  manifestations  of  pain  there  are 
other  valuable  resources  upon  which  one  may  rely.     In- 


SURGICAL  TREATMENT  OF  COLICS  57 

spection  of  the  abdomen  often  aids  materially  in  arriv- 
ing at  positive  conclusions  as  to  the  seat  of  the  trouble 
and  while  deep  abdominal  pressure,  depended  upon  so 
much  by  doctors  of  human  medicine,  is  of  service  only 
in  small  animals,  we  have  in  large  animals  the  advantage 
of  exploration  per  rectum  which  will  yield  a  great  wealth 
of  diagnostic  information  to  anyone  who  will  but  prac- 
tice diligently  this  method  of  searching  for  abnormalties. 
To  the  unskilled  hand  all  rectal  explorations  are  alike, 
but  the  experienced  diagnostitian  is  capable  of  making 
wonderfully  accurate  deductions  from  what  his  hand 
palpates. 

In  the  earlier  days  of  my  career  as  a  practitioner  I 
doubted  the  possibility  of  recognizing  a  twisted  colon, 
but  after  having  read  positive  statements,  to  this  effect, 
from  others,  especially  European  writers,  I  became  more 
inquisitive  and  finally  discovered  that  torsion  of  the 
colon  is  not  only  easy  to  diagnose  but  the  exact  direction 
of  the  twist  even  can  be  determined  with  precision.  And 
so  it  is  with  other  conditions  if  we  would  but  search  for 
them  more  often  than  we  are  in  the  habit  of  doing. 

The  rectal  and  vaginal  routes  offer  a  wide  field  for  ex- 
plorations which  are  fruitful  or  useless  in  accordance  to 
the  training  that  the  hand  that  makes  them  has  received. 
The  condition  of  the  large  colon,  the  small  colon,  the 
cecum,  the  inguinal  rings,  the  kidneys,  the  uterus  and 
of  the  ovaries  can  be  determined  by  these  manipulations. 
Impactions,  new  growths,  cysts,  calculi,  torsions,  and  ab- 
scesses can  be  diagnosed  in  this  manner.  Why  then  wait 
for  the  autopsy  for  a  diagnosis  with  this  wide  open  route 
available  during  life? 

Then   again  we  may  take  advantage  of  exploratory 


58  COLICS  AND  THEIR  TREATMENT 

punctures  and  stomach  cathetrization  in  many  instances 
to  determine  more  accurately  the  nature  of  alimentary 
disorders  of  an  acute  character. 

This  paper  is  not  designed  to  be  a  discourse  on  diag- 
nosis, but  I  can  not  very  well  introduce  my  subject 
logically  without  first  showing  the  possibility  of  locating 
the  seat  and  cause  of  abdominal  pain  with  a  degree  of 
accuracy  that  would  warrant  the  recommendation  of 
treatment  by  instrumentation.  A  surgical  operation  is 
justified  only  when  directed  at  a  definite  object  and 
when  this  object  cannot  be  located  accurately  then  the 
surgeon  must  leave  the  condition  in  the  therapeutist's 
category.  On  this  account  the  following  remarks  deal  at 
some  length  with  the  diagnosis  of  the  condition  the  oper- 
ation is  intended  to  cure. 

ACUTE  PAINFUL  DISEASES   OF  THE 
STOMACH 

The  stomach  of  animals  is  subject  to  the  following 
disorders  which  cause  acute  pain: 

1.  Overloading  of  the  stomach  of  work  horses.  In 
this  country  almost  universally  called  "acute  indigestion." 

2.  Impaction  of  the  stomach. 

3.  Acute  gastritis. 

4.  Acute  dilatation  of  the  stomach. 

It  will  be  noticed  here  that  without  going  beyond  the 
stomach  we  already  find  four  definite  disorders,  each  of 
which  I  shall  endeavor  to  show  belongs  to  the  list  of 
surgical  diseases.  Some  of  them  may  yield  to  medical 
treatment  and  when  of  a  mild  type  may  still  properly 
remain  in  the  list  of  medical  diseases,  but  when  they  are 
grave,  the  aid  of  the  surgeon  must  be  enlisted  or  the 
patient  will  not  survive.    Let  us  analyze  them  separately. 


SURGICAL  TREATMENT  OF  COLICS  59 

Overloading  of  the  Stomach  of  Work  Horses 

Acute  indigestion,  so-called,  is  so  well  known  to  all 
practitioners  that  its  symptoms  need  no  special  descrip- 
tion here.  It  is  so  characteristic  and  its  characteristics 
are  so  well  known  that  there  is  little  chance  of  mistak- 
ing it  for  any  other  disorder.  Esophageal  obstruction 
(choke)  in  the  very  first  stage  and  poisoning  with  aconite 
are  the  only  two  conditions  for  which  it  might  by  any 
chance  be  mistaken  and  these  are  very  easily  excluded 
by  a  little  study. 

Symptoms. — The  eructations  of  gas,  the  activity  of 
the  esophagus  in  the  cervical  region,  the  distended  ab- 
domen which  may  be  slight  or  threatening,  the  colicky 
pains  of  a  fairly  acute  character,  occurring  in  a  horse 
after  a  day's  work,  sometimes  before  and  sometimes 
after  having  eaten  the  evening  meal  is  a  clinical  picture 
that  is  at  once  recognized  as  an  overloaded  stomach. 

Here  the  volume  of  water  and  feed  is  too  great  for 
the  exhausted  stomach  to  handle.  Gases  pass  readily 
from  the  stomach  into  the  bowels  and  these,  too,  become 
bloated.  In  the  more  formidable  cases  large  quantities 
of  chyme  are  washed  into  the  intestinal  tract,  until  all 
of  the  bowels  as  far  back  as  the  floating  colon  is  teem- 
ing with  a  fermenting  process. 

Treatment. — Mild  cases  may  take  a  favorable  turn 
without  any  treatment  and  will  usually  respond  to  the 
administration  of  antiferments,  of  which  salicylic  acid, 
recommended  by  Quitman  is  probably  the  best,  but  when 
the  attack  is  of  a  severe  type  only  radical  measures  un- 
dertaken promptly  will  prevent  a  fatal  termination.  The 
radical  measures  to  which  I  refer  are  catherization  of 


60  COLICS  AND  THEIR  TREATMENT 

the  stomach  and  puncture  of  the  colon  if  the  bloating  is 
threatening. 

Cathetrization  of  the  stomach  is  practiced  extensively 
in  this  country,  but  in  spite  of  its  merits  as  a  radical  cure 
it  has  by  no  means  been  universally  adopted  as  the  stand- 
ard intervention  against  an  overloaded  stomach,  as  it 
should  have  been  long  ago. 

Here  is  an  operation  that  goes  to  the  "fountain-head" 
of  the  trouble  and  without  ceremony  removes  it  from  the 
body.  To  fight  a  stubborn  fermentation  in  such  a  mass 
of  chyme  and  then  start  the  whole  volume  through  its 
long  course  to  the  rectum  by  means  of  drugs  seems 
criminal  with  such  a  splendid  operation  available. 

Those  who  have  practiced  this  operation  have  little 
patience  with  the  uncertain  and  slow  medical  treatment. 
Stomach  cathetrization  not  only  evacuates  the  harmful 
contents,  but  it  also  lowers  the  abdominal  tension,  and 
besides  the  dilution  of  the  chyme  with  water  controls  the 
fermentation  more  effectually  than  any  other  form  of 
antiferment  treatment,  and  leaves  what  remains  of  the 
mass  in  a  better  physical  condition  for  the  intestines  to 
handle.  And  often  animals  almost  dead  from  acute  in- 
digestion, destined  by  medical  treatment  to  go  through  a 
prolonged  agony,  followed  by  death  or  sometimes  to  end 
in  laminitis,  are  cured  immediately  and  ready  for  work 
in  a  few  hours. 

The  Single  Stomach  Tube  Favored 

The  first  question  usually  asked  in  connection  with 
stomach  catherization  is :  "Which  is  the  better  tube,  the 
single  or  the  double  one?"  And  the  second  query  is  in- 
variably an  inquiry  as  to  the  better  route  through  which 


SURGICAL  TREATMENT  OF  COLICS  6i 

to  pass  it.  Both  of  the  questions  are  indeed  pertinent, 
and  therefore  need  detailed  replies. 

The  fact  that  we  have  finally  adopted  the  single  tube 
in  our  practice  in  preference  to  the  double  one,  after 
years  of  experimentation  with  both  of  them,  leaves  us  no 
choice  but  that  of  recommending  the  former;  and  yet 
this  decision  need  not  be  interpreted  as  a  final  condem- 
nation of  the  double  tube  which  has  many  adherents. 
We  discarded  it  because  we  found  it  possesses  no  ad- 
vantages of  sufficient  importance  to  offset  its  greater  cost, 
and  because  we  have  yet  to  find  a  double  tube  of  suffi- 
cient internal  caliber,  and  at  the  same  time  durable 
enough  to  meet  the  approval  of  the  veterinarian,  who 
keeps  it  in  constant  use. 

A  stomach  tube  is  a  somewhat  cumbersome  affair  to 
carry  with  one,  without  exposing  it  to  harsh  treatment, 
therefore  the  more  complex  it  is  the  more  likely  it  is 
to  become  damaged  in  one  way  or  other. 

Gastric  lavage  with  a  tube  having  both  an  influx  and  a 
reflux  channel  has  been  practiced  by  human  physicians 
for  years,  and  it  is  evidently  from  this  practice  that 
veterinarians  have  conceived  the  idea  of  applying  the 
same  method  to  the  treatment  of  animals.  In  principle, 
the  idea  seems  good,  but  when  put  into  practice  side  by 
side  with  lavage  with  a  single  hose  it  is  soon  found  that 
in  horses  the  actual  force  of  the  pump  has  very  little  in- 
fluence in  forcing  out  material  from  the  stomach.  The 
intra-abdominal  pressure  after  all  must  be  depended 
upon  to  bring  out  the  accumulated  material,  and  this  pres- 
sure is  nearly  always  present  when  stomach  cathetriza- 
tion  is  required. 


62  COLICS  AND  THEIR  TREATMENT 

A  single  tube,  smooth,  pliable,  soft  and  with  a  lumen 
large  enough  to  allow  solids  to  flow  out  freely  is  the 
ideal  one  to  select.  A  harsh  or  hard  tube  is  a  dangerous 
weapon.  Our  old  tubes  which  have  become  stretched 
and  soft  from  long  use  we  regard  as  precious  instru- 
ments. In  fact,  we  always  deplore  the  necessity  of 
"breaking  in"  a  new  one,  when  finally  an  old  one  is  worn 
out.  A  rattan  stylet  is  an  essential  adjunct  to  a  soft  tube 
as  it  of  itself  is  too  pliable  to  pass  through  the  tortuous 
route  to  the  stomach  without  something  to  stiffen  it. 
A  large  soft  tube  with  a  lumen  much  larger  than  the  di- 
ameter of  the  stylet  is  such  a  pliable,  yielding  object  that 
it  is  perfectly  compatible  with  the  route  over  which  it 
must  travel  and  with  the  delicate  tissues  upon  which  it 
must  sojourn  during  the  more  or  less  protracted  opera- 
tion. These  facts  have  been  so  conspicuously  revealed  to 
us  that  we  no  longer  regard  them  as  controvertible  or 
even  subjects  for  further  discussion. 

Selection  of  the  Passage 

As  to  the  route  through  which  to  pass  a  hose  to  the 
stomach  of  a  horse,  we  have  found  the  nasal  route  the 
more  satisfactory.  When  the  oral  route  is  chosen  the 
mouth  must  either  be  held  open  with  a  mouth  speculum 
or  else  tied  shut  with  a  strap  or  rope.  Both  of  these 
maneuvers  require  precious  time,  and  are  always  op- 
posed vigorously  by  the  patient;  furthermore,  the  op- 
position is  usually  continued  during  the  whole  procedure, 
in  marked  contrast  to  the  remarkable  complacency  with 
which  the  patient  always  allows  a  tube  to  rest  in  the 
nose  throughout  the  procedure,  however  protracted.  The 
nasal  route  has  the  disadvantage  of  an  occasional  epis- 


SURGICAL  TREATMENT  OF  COLICS  63 

taxis,  but  as  this  is  never  a  serious  hemorrhage,  and  can 
be  prevented  by  practicing  more  gentle  manipulations  as 
the  hose  is  passing  through  the  turbines,  but  little  ob- 
jection can  be  raised  for  this  reason.  The  chief  ad- 
vantage of  the  nasal  route  is  the  facility  with  which  the 
tube  can  be  passed  without  ceremony  into  the  stomach 
and  without  any  preparatory  step  like  adjusting  a  specu- 
lum or  nose  strap.  In  short,  it  is  a  wide  open,  ever-ready 
channel  through  which  a  hose  can  always  be  passed  with- 
out formidable  opposition  from  the  patient. 

Modus  Operandi  of  Stomach  Lavage 

The  modus  operandi  as  practiced  in  our  establishment 
is  as  follows :  Ten  to  twenty  gallons  of  hot  water  are 
usually  needed  and  as  hot  water  in  such  quantities  is  not 
always  available  the  first  step  is  to  plan  to  have  this  mat- 
ter provided  for  while  the  other  appurtenances  and  the 
patient  are  being  prepared.  There  should  be  a  vessel  to 
catch  the  reflux  and  one  to  hold  the  hot  water.  It  is  not 
good  practice  to  allow  the  reflux  to  flow  upon  the  floor 
since  it  is  rather  important  to  keep  some  account  of  the 
relations  between  the  amount  of  water  pumped  into  the 
stomach  and  the  material  that  flows  out  of  it. 

The  stylet  is  well  lubricated  with  vaseline  and  pushed 
into  the  hose  until  its  end  reaches  to  a  point  one  inch 
from  the  end  of  the  tube.  If  the  end  of  the  stylet  is  too 
near  the  end  of  the  tube  it  may  be  pushed  out  in  passing 
downward  and  thus  inflict  damage,  and  if  more  than  one 
inch  from  the  end  of  the  tube  the  latter  may  fold  upon 
itself  and  block  the  channel. 

The  intensive  lubrication  of  the  stylet  to  facilitate  its 


64  COLICS  AND  THEIR  TREATMENT 

removal  when  the  tube  has  reached  the  stomach  and 
placing  it  so  that  its  end  is  one  inch  from  the  end  of  the 
tube  are  both  essential  preparatory  measures. 

The  patient,  everything  being  ready,  is  backed  into  a 
single  stall  and  tied  loosely  to  the  pillar  rein,  preferably 
with  a  good  strong  dental  halter.  Cases  in  the  throes  of 
violent  pains  should  be  tied  carefully  to  provide  against 
injury  in  case  of  sudden  decumbency.  The  left  nostril 
is  usually  chosen.  The  tube  is  lubricated  with  a  soft 
vaseline,  but  the  entire  length  should  not  be  lubricated 
at  once,  as  it  may  become  soiled  by  litter  adhering  to  it 
during  the  first  maneuvers  of  the  operation.  It  is  best 
to  lubricate  only  about  eighteen  inches  and  then  apply 
vaseline  to  the  remainder  as  fast  as  it  enters  the  nostril. 
In  this  manner  the  tube  is  kept  free  from  any  grit,  litter, 
earth  or  any  other  loose  objects  over  which  it  is  certain 
to  be  trailed. 

The  end  of  the  tube  is  held  in  the  right  hand,  which 
now  directs  it  along  the  floor  of  the  nasal  fossa  by  a 
firm  pressure,  as  the  left  hand  slowly  pushes  it  back- 
ward. When  buried  ten  inches  the  head  should  be  ex- 
tended to  bring  the  channel  through  which  the  tube  must 
pass  nearer  to  a  straight  line.  The  tube  may  now  be  taken 
in  both  hands  and  pushed  right  down  without  further 
hesitation,  except  to  lubricate  it  with  vaseline  as  fast  as 
it  enters. 

The  timid,  unskilled  operator  may  stop  momentarily 
after  three  feet  of  the  tube  has  entered  to  palpate  the 
neck  to  assure  himself  it  has  not  passed  into  the  trachea, 
an  accident  that  very  seldom,  if  ever,  occurs,  when  a 
stylet  is  used.    With  the  limber  rubber  tube  passed  with- 


SURGICAL  TREATMENT  OF  COLICS  65 

out  a  stylet  entrance  into  the  trachea  was  a  very  fre- 
quent occurrence,  and  sometimes  the  operation  would 
have  to  be  abandoned,  because  despite  everything,  the 
tube  could  not  be  made  to  enter  the  esophageal  infundi- 
bulum,  but  instead,  it  persisted  in  dropping  into  the 
larynx.  Sometimes  it  would  pass  as  far  down  as  the 
lungs  without  warning. 

It  would  seem  that  the  entrance  of  a  tube  into  the 
glottis  would  immediately  and  certainly  cause  a  fit  of 
coughing,  but  this  is  not  the  case.  Coughing  does  not 
occur  to  warn  the  operator.  The  only  real  warning  that 
a  tube  has  entered  the  trachea  is  the  ease  with  which  it 
enters  the  trachea  as  compared  with  the  force  required 
to  push  it  down  the  esophagus. 

The  danger  of  forcing  a  tube  into  the  lower  air  pas- 
sages is  negligible  when  the  stylet  is  used.  In  fact,  we 
have  not  had  this  accident  occur  since  using  a  stylet. 
Furthermore,  a  styletted  tube  can  always  be  felt  in  the 
neck.  Holding  the  free  end  of  the  tube  to  the  ear  to 
listen  for  respiratory  sound  must  not  be  depended  upon 
as  blowing  sounds  synchronous  with  the  respirations  may 
be  heard  from  the  esophagus,  as  well  as  from  the  trachea. 
The  only  auscultation  of  any  service  here  is  that  which 
reveals  the  gurgling  sounds  of  escaping  gases,  and  these 
can  always  be  heard  as  the  tube  approaches  the  cardiac 
orifice. 

When  the  tube  has  entered  the  stomach,  determined 
either  by  measurement  or  by  the  gushing  of  gas  or 
chyme  the  stylet  is  removed.  This  feat  requires  the  full 
strength  of  a  man,  who  pulls  forward  on  the  stylet  as  the 
operator  pulls  backward  upon  the  tube.     It  is  here  that 


66  COLICS  AND  THEIR  TREATMENT 

the   necessity   for  lubricating  the   stylet   well   is   appre- 
ciated. 

The  operation  of  washing  out  the  contents  of  the  stom- 
ach now  begins.  Water  at  110°  F.  is  used.  Often  large 
quantities  of  material  will  flow  out  as  soon  as  the  stylet 
is  removed,  but  when  the  flow  ceases  the  water  is 
pumped  in,  first  in  small  quantities,  detaching  the  tube 
from  the  pump  frequently  to  allow  the  syphoning  to  con- 
tinue. When  there  is  no  more  reflux  from  this  alternate 
pumping  and  syphoning  two  or  even  three  gallons  of  the 
hot  water  may  then  be  pumped  in  slowly,  watching  cau- 
tiously all  the  while  for  a  well  marked  distress  the  over- 
filling of  the  stomach  always  produces.  When  this  is 
observed  the  pump  is  again  detached  and  the  contents 
allowed  to  flow  out  again.  This  may  be  repeated  ad 
libitum  so  long  as  a  more  or  less  accurate  account  is 
kept  of  the  difference  between  the  amount  pumped  in  and 
the  amount  evacuated.  The  desideratum  being  to  leave 
at  least  as  much  in  volume  in  the  viscera  as  was  evacu- 
ated. Six  to  eight  ounces  of  ether,  stirred  into  the  water, 
may  be  pumped  into  the  stomach  as  a  parting  treatment. 

This  describes  fairly  well  our  procedure  against  acute 
indigestion  and  acute  gastritis,  the  two  chief  diseases  for 
which  stomach  cathetrization  is  indicated. 

Sequels  of  Stomach  Cathetrization 

The  sudden  evacuation  of  the  overwhelmed  viscera 
particularly  if  the  attack  has  been  of  several  hours'  dura- 
tion may  be  followed  by  shock  on  resumption  of  the 
splanchnic  circulation  that  had  been  dammed  up  by  the 
pressure.    It  may  be  mild,  serious,  or  even  fatal,  accord- 


SURGICAL  TREATMENT  OF  COLICS  67 

ing  as  the  causes  and  conditions  of  the  patient  chance  to 
operate. 

An  old  subject  or  one  systemically  weak  from  con- 
tinued hard  work  that  has  suffered  two  or  three  hours 
from  an  overloaded  stomach  if  suddenly  relieved  will 
often  begin  to  show  symptoms  of  collapse  from  one-half 
hour  to  six  hours  after  the  operation.  The  weakened 
viscera,  overcome  by  the  prolonged  stretching,  take  more 
than  their  share  of  the  blood  volume  and  this  at  the  ex- 
pense of  the  periphery.  The  result  is  shock;  but  this 
may  very  frequently  be  prevented  by  injecting  large  vol- 
umes of  hot  water  into  the  stomach  after  the  harmful 
contents  have  been  removed.  The  sudden  relief  of  a 
badly  overwhelmed  abdomen  is  a  hazard  at  all  times 
when  this  precautionary  treatment  is  omitted. 

Laminitis  is  of  course  always  liable  to  follow  such  a 
disorder  and  while  cathetrization  of  the  stomach  does  not 
always  prevent  it  we  have  found  that  the  instillation  of 
alum,  five  ounces  in  solution,  as  a  parting  step  of  the 
operation  is  markedly  preventive.  In  our  practice 
stomach  cathetrization  has  even  been  charged  with  caus- 
ing laminitis,  but  the  reason  we  had  so  many  cases  at 
first  is  due  to  the  fact  that  before  we  practiced  stomach 
cathetrization  these  bad  cases  died  before  laminitis  could 
develop.  When  we  began  to  prolong  the  life  of  these 
otherwise  fatal  cases  we  found  that  some  of  them  fell 
victims  to  this  complication.  Now  alum  has  come  to 
our  rescue. 

Alum  for  laminitis  was  first  given,  to  my  knowledge, 
by  Doctor  Douglas,  of  New  Orleans.  Since  he  an- 
nounced this  remedy  several  years  ago  it  has  come  into 


68  COLICS  AND  THEIR  TREATMENT 

pretty  general  use  in  the  West.  I  heard  of  it  in  Cali- 
fornia last  winter  where  at  least  one  veterinarian  ad- 
ministers it  in  quantities  up  to  one  pound. 

A  third  sequel  of  stomach  lavage  is  acute  dilatation  of 
the  stomach,  of  which  I  shall  speak  later. 
Impaction  of  the  Stomach 

Impaction  of  the  stomach  is  a  condition  I  fear  veteri- 
narians have  too  frequently  failed  to  recognize.  It  is  in- 
variably referred  to  as  a  senile  trouble  in  our  literature 
and  is  usually  attributed  to  chronic  dilatation  of  the 
stomach  and  in  animals  fed  exclusively  upon  a  dry  fibrous 
forage. 

While  such  is  often  the  case  under  which  the  disease 
is  encountered  it  is  by  no  means  limited  to  old  animals. 
We  have  found  numerous  grave  impactions  in  young, 
vigorous  horses  with  great  frequency.  Straw,  hay, 
shredded  fodder,  coarse  ensilage,  alfalfa  or  even  clover 
hay  partaken  of  ravenously,  is  the  usual  cause.  The  cases 
in  our  urban  practice  are  found  chiefly  among  horses  in 
small  establishments  where  the  food  is  carelessly  or 
irradically  allowed,  that  is,  a  spare  ration  today  and  a 
liberal  one  tomorrow.  In  short,  the  hungry  horse,  after 
a  day  or  two  of  hard  work  and  privation,  suddenly  given 
access  to  a  full  manger,  is  found  sick  with  impaction  of 
the  stomach  the  following  morning,  or  falls  sick  in  the 
harness  during  the  next  day. 

Symptoms. — The  symptoms  of  this  affection  are 
characteristic.  The  pains  are  fairly  acute  and  as  the  pa- 
tient finds  no  comfort  in  the  recumbent  position — is  con- 
tinually up  and  down.  There  is  always  a  marked  perspira- 
tion about  the  neck  and  shoulders.    The  respirations  are 


SURGICAL  TREATMENT  OF  COLICS  G9 

short  and  the  nostrils  widely  dilated.  Sometimes  there 
is  a  grunt  heard  during  the  exhalations,  particularly 
noticeable  while  the  patient  is  recumbent.  The  absence 
of  abdominal  distention  to  account  for  this  distressing 
respiration  is  in  fact  pathognonomic  when  coupled  with 
the  above  symptoms.  There  may  be  some  bloating  of 
the  right  flank  that  becomes  more  pronounced  as  the 
disease  progresses,  but  the  bloating  is  never  sufficient  to 
account  for  the  grave  condition  of  the  patient  and  only 
momentary  relief  is  afforded  when  it  is  evacuated  with 
the  trocar  and  canula. 

Treatment. — Allowed  to  run  its  course  or  under  the 
ordinary  medical  treatment  usually  administered  for  col- 
ics, impaction  of  the  stomach  runs  rapidly  toward  a  fatal 
ending.  Eserine,  by  further  exhausting  the  stomach  in 
the  futile  contractions  to  expel  its  contents,  is  always 
disastrous  in  impaction  of  the  stomach  and  the  same  ap- 
plies to  the  other  powerful  drugs  resorted  to  for  serious 
colics.     Oil  and  purgatives  afford  no  relief  whatever. 

The  only  remedy  I  have  found  to  turn  these  fatal  cases 
toward  recovery  is  to  patiently  liquify  the  impacted  mass 
and  endeavor  to  aspirate  it  out  through  the  tube.  The 
operation  requires  patience,  as  this  feat  cannot  be  ac- 
complished immediately.  The  injections  of  two  or  three 
gallons  of  water  into  the  already  full  stomach  may  ac- 
tually increase  the  patient's  agony,  but  after  a  time  when 
the  water  has  had  time  to  distribute  itself  through  the 
mass,  the  injection  of  additional  quantities  of  water  will 
begin  to  bring  out  food  particles  in  the  reflux  and  finally, 
as  the  softening  process  continues,  more  will  flow  out. 
After  a  patient  attempt  without  success  a  second  or  third 


70  COLICS  AND  THEIR  TREATMENT 

attempt  may  be  made  at  intervals  of  an  hour.  As  much 
as  forty  or  fifty  pounds  of  solids  may  be  removed  from 
the  stomach  in  this  way,  thus  placing  an  otherwise  fatal 
case  well  toward  recovery. 

Such  patients  are,  however,  invalids  for  some  time  and 
are  subject  to  subsequent  attacks  of  colic,  probably  due 
to  chronic  dilatation. 

Acute  Gastritis 

Acute  gastritis  is  the  most  severe  as  well  as  the  most 
fatal  of  colics  if  not  promptly  recognized  and  relieved. 
It  is  seen  under  two  distinct  circumstances.  First  after 
a  hard  day's  work  or  long,  tiresome  journey,  and,  sec- 
ondly, after  eating  tainted  food.  Sometimes  these  causes 
operate  together.  Ground  foods  containing  poor  quali- 
ties of  corn,  oats,  barley  and  mill  feed  are  responsible  in 
many  cases,  particularly  when  there  is  a  sudden  change 
to  these  feeds. 

Symptoms. — The  animal  is  stricken  on  the  road  or 
soon  after  having  reached  the  stable  and  always  before 
having  eaten  the  evening  meal.  The  patient  suffers  hor- 
rible agony  and  cannot  be  controlled,  thrashing  about  in 
a  terrifying  manner.  There  is  usually  a  threatening  ab- 
dominal bloat  that  calls  for  immediate  relief  from  the 
trocar  and  canula.  This  operation  gives  only  a  momen- 
tary comfort.  Belching  is  not  a  constant  symptom,  al- 
though there  is  generally  a  perceptible  activity  of  fluids 
in  the  esophagus.  The  respirations  are  accelerated,  the 
nostrils  dilated,  the  body  bathed  in  perspiration,  the  tem- 
perature is  elevated  to  104°  to  105°  F.  and  the  mucous 
membranes  are  highly  injected.    In  hot  weather  the  body 


SURGICAL  TREATMENT  OF  COLICS  71 

temperature  is  sometimes  very  high  as  this  disorder  may 
be  associated  with  overheating  of  the  body. 

Treatment. — The  pathognomonic  symptoms  are 
found  in  the  course  of  the  treatment,  which  consists  of 
the  prompt  washing  out  of  the  stomach  with  the  stomach 
tube  and  pump.  The  contents  which  usually  flow  out  as 
soon  as  the  tube  reaches  the  cardiac  orifice  are  blood 
stained  with  the  exudates  from  the  inflamed  mucous 
membrane.  It  is  sour  and  flows  out  in  sufficient  quan- 
tity to  afford  an  immediate  relief.  As  the  tube  enters 
the  stomach  the  patient,  till  then  in  great  agony,  im- 
mediately stands  quiet. 

The  volume  of  solids  evacuated  from  such  a  stomach 
is  always  small  and  can  in  no  way  account  for  the 
patient's  agony.  The  extreme  pain  is  the  pain  of  in- 
flammation and  not  entirely  of  engorgement  as  in  acute 
indigestion.  The  stomach  should  be  well  washed  out  by 
alternate  instillation  and  aspiration  of  hot  water  until 
the  reflux  is  clear  and  then  several  gallons  of  hot  water 
are  injected  to  fill  the  stomach  and  guard  against  a  too 
sudden  reaction  of  the  gastric  circulation. 

In  these  cases  we  also  use  the  alum  solution  to  prevent 
laminitis.  One-half  of  a  grain  of  strychnine  is  helpful, 
and  in  twenty  hours  a  small  dose  of  linseed  oil  is  given 
to  prevent  the  constipation  that  otherwise  may  follow 
two  days  later. 

Acute  Dilatation  of  the  Stomach 

Acute  dilatation  of  the  stomach  is  a  sequel  of  the  above 
disorders  and  is  due  to  an  exhaustion  of  the  muscles 
from  the  severe  and  especially  from  the  prolonged 
stretching  to  which  the  stomach  was  subjected.    In  some 


72  COLICS  AND  THEIR  TREATMENT 

instances  the  walls  give  way  to  the  stretching  and  rup- 
ture occurs.  Dilatations  follow  stomach  colics  in  which 
there  is  little  or  no  bloating  in  the  bowels  or  when  the 
bloat  in  the  bowels  is  suddenly  relieved  by  evacuation  of 
the  gases  with  the  trocar  and  canula.  As  long  as  the 
stomach  is  pressed  upon  by  bloated  bowels  its  walls  are 
supported  against  stretching  or  rupture,  but  when  bloat 
is  absent  or  is  relieved  it  distends  in  a  backward  di- 
rection and  either  stretches  into  a  serious  dilatation  or 
else  gives  way  entirely.  It  is  therefore  important  in 
treating  overwhelmed  stomachs  to  relieve  the  distention 
by  catheterization  and  then  if  necessary  attend  to  the 
gases  in  the  large  bowels.  To  reverse  these  operations 
is  hazardous. 

Every  bad  case  of  acute  indigestion,  impaction  and  gas- 
tritis is  followed  by  more  or  less  dilatation  with  which 
the  surgeon  in  charge  should  reckon.  In  the  vigorous 
subject,  given  prompt  treatment  of  the  proper  kind,  the 
stretched  organ  almost  immediately  resumes  its  normal 
state  and  is  ready  to  functionate  in  the  normal  manner; 
in  others  the  reaction  requires  several  days  and  in  some 
it  runs  rapidly  to  a  fatal  end  or  leaves  the  stomach  a 
prey  to  frequent  similar  attacks  and  the  patient  a  victim 
of  chronic  indigestion. 

In  order  that  I  may  not  be  misunderstood  I  should 
mention  here  that  we  use  the  phrase  "dilatation  of  the 
stomach"  to  designate  exclusively  the  stretched  stomach 
that  does  not  immediately  contract  after  the  material 
engorging  it  has  been  removed.  The  term  is  used  by 
some,  notably  by  Hutyra  and  Marek,  as  synonymous 
with  engorgement  of  the  stomach,  whether  the  organ  is 


SURGICAL  TREATMENT  OF  COLICS  73 

damaged  by  the  stretching  or  not,  while  here  I  am  re- 
stricting its  meaning  to  the  more  or  less  permanent  dam- 
age done  by  the  stretching.  That  is,  dilatation  of  the 
stomach  is  that  state  in  which  the  muscularis  does  not 
contract  back  to  a  normal  state  when  the  bloat  is  re- 
lieved. 

Symptoms. — The  effects  of  dilatation  vary  from  a  de- 
layed return  of  the  patient's  health  after  an  attack  of 
colic  lasting  several  days,  in  mild  cases,  to  the  gravest 
symptoms  of  fatal  shock  in  severe  cases.  A  bad  case  of 
dilatation  of  the  stomach  following  a  severe  stomach  colic 
presents  all  of  the  symptoms  of  a  rupture  of  the  stomach. 
There  may  be  free  vomition  and  the  peripheral  coldness, 
cold  perspiration,  running  down  pulse  rate,  empty  arteries, 
labored  breathing,  and  tremors  about  the  shoulders  and 
flanks  combine  to  bring  about  a  clinical  picture  that  all 
practitioners  recognize  as  signs  of  approaching  death. 

Treatment. — The  prevention  of  dilatations  is  found 
in  the  prompt  relief  of  gastric  colics  by  catheterization. 
It  is  also  important  to  avoid  a  too  sudden  evacuation  of 
colonic  bloat  when  the  stomach  is  overwhelmed.  This  is 
a  fine  point  in  the  treatment  of  colics  I  would  like  to  im- 
press upon  the  reader.  And  lastly  the  stomach  after  hav- 
ing been  relieved  of  its  harmful  contents  should  be  re- 
filled with  hot  water.  These  recommendations  are  par- 
ticularly essential  in  stomach  colics  of  old  horses  and  in 
those  of  some  hours'  duration. 

Weak  solutions  of  aromatic  spirits  of  ammonia  in- 
stilled into  the  stomach  as  a  parting  treatment  is  beneficial 
to  the  weakened  circulation,  strychnine  subdermally  is 
helpful  and  warm  clothing,  body  frictions  and  sinapisms 
cannot  be  overdone. 


74  COLICS  AND  THEIR  TREATMENT 

THE  SMALL  INTESTINES 

The  small  intestines  are  subject  to  very  grave  condi- 
tions which  cause  colics,  and  pain  located  in  them  is  the 
most  violent  of  all  abdominal  pains,  and  the  more  an- 
teriorally  the  trouble  is  located  the  more  intense  is  the 
pain.  A  diagnosis  of  colic  in  the  small  intestines  is  made 
by  the  intense  agony  the  patient  suffers  and  continues 
to  suffer  throughout.  Whenever  a  horse  throws  itself 
about  recklessly  and  violently  and  is  beyond  control, 
often  falling  to  the  floor  with  the  full  weight  of  the 
body,  time  after  time,  without  a  moment  of  relief,  ex- 
cept, possibly,  when  it  rolls  into  a  dorsal  position  against 
the  wall,  it  is  pretty  safe  to  diagnose  colic  in  the  small 
intestines,  and  the  antero-posterior  location  may  be  judged 
by  the  intensity  of  the  pains.  The  duodenum  and  jejun- 
um cause  a  more  intense  pain  than  the  ileum,  other 
things  being  equal. 

The  small  intestines,  especially  of  large  animals,  are 
not  affected  with  conditions  that  can  be  successfully  man- 
aged by  surgery  and  they  are  only  mentioned  here  to 
carry  out  our  plan  of  differentiating  colicky  pains.  Our 
loss,  however,  in  this  connection  is  not  great  and  should 
not  be  discouraging,  because  bowel  surgery  for  intrinsic 
conditions  are  pretty  hopeless  anywhere.  Even  the 
human  surgeon  despairs  at  the  necessity  of  cutting  into 
the  intestinal  tract,  and  if  we  are  denied  the  benefit  of 
such  intervention  we  are  not  denied  much  that  is  suc- 
cessful. 

I  know  that  surgical  literature  records  enterotomies, 
enterectomies,  and  approximations  with  a  recklessness 
that  would  lead  a  reader  to  believe  that  these  are  but 


SURGICAL  TREATMENT  OF  COLICS  75 

commonplace  every-day  trivialities,  but  when  one  scans 
statistics  of  mortalities  and  ontoward  sequelae,  we  vet- 
erinarians may  be  thankful  that  our  animal  patients  are 
not  suitable  subjects  for  such  operations. 

The  diseases  of  the  small  intestines  found  in  the  horse 
with  sufficient  frequency  to  be  called  common  diseases 
are: 

Enteritis 

Enteritis  may  be  local,  from  a  local  obstruction,  but 
more  often  it  affects  a  more  extensive  area.  The  whole 
tract  including  the  stomach  and  large  intestines  may  be  af- 
fected. It  probably  always  has  its  origin  in  faulty  ali- 
mentation, but  early  in  the  course  of  the  pain  bacteria 
play  the  important  role  and  thus  produce  a  condition 
that  no  surgical  operation  could  benefit. 
Obstruction 

Obstipations  from  fibrous  forage  or  unnatural  food 
may  cause  obstruction  at  one  point  or  over  a  consider- 
able portion  of  the  small  bowels.  Circumscribed  obstruc- 
tions may  cause  pouching  of  the  gut  at  the  point  affected 
and  thus  leave  a  place  for  future  accumulations.  Clay, 
sand,  or  foreign  bodies  may  lodge  in  the  small  intestine 
of  dogs  and  in  ruminants,  foreign  bodies  may  pass  the 
fourth  stomach  and  lodge  at  or  behind  the  pylorus.  Here 
again  we  cannot  successfully  operate  for  them  even  if 
we  should  eventually  succeed  in  diagnosing  these  cases. 
Volvulus  and  Invaginations 

Volvulus  and  invaginations  are  common  enough  to 
warrant  a  very  close  study  of  the  early  symptoms.  And 
it  is  a  pity  we  do  not  diagnose  them  early,  because  here 
we  have  conditions  which  could  be  relieved  by  extrinsic 


76  COLICS  AND  THEIR  TREATMENT 

manipulations  and  would  therefore  be  less  hazardous 
than  operations  requiring  invasion  of  the  lumen.  I  re- 
gret to  say  that  I  have  never  been  able  to  find  these 
conditions  except  at  the  postmortem  examinations. 

THE  LARGE  INTESTINES 

Pain  in  the  large  bowels  is  easy  to  differentiate  from 
pain  in  the  stomach  or  small  intestines.  It  is  always  of 
a  milder  type  and  often  intermittent.  It  may  last  for 
days.  In  practically  all  of  the  autopsies  I  have  had  the 
opportunity  to  hold  on  animals,  dead  after  long  sieges  of 
colic,  the  incriminating  lesion  was  found  in  the  large 
bowels.  The  pain  may  be  acute  in  the  early  stage,  but 
this  soon  gives  way  to  one  that  is  milder  and  lasting. 

Sitting  upon  the  haunches,  dog-like,  points  to  trouble 
in  the  large  bowels.  The  common  sign  of  turning  the 
nose  toward  the  flank  is  also  one  that  is  seen  more  often 
in  disorders  of  the  large  bowels  than  of  the  small  ones, 
although  too  much  dependence  must  not  be  placed  upon 
this  symptom  because  the  same  manifestation  may  be 
seen  in  almost  any  form  of  colic.  The  act  of  holding  the 
nose  at  the  flank  for  some  moments  at  the  time  is,  how- 
ever, a  certain  indication  of  a  grave  condition,  like  strang- 
ulated hernia,  volvulus,  invagination  or  fatal  local  ob- 
struction of  some  other  character. 

In  stomach  colics  there  is  always  the  telltale  dilatation 
of  the  nostrils  and  local  sweating  about  the  fore  parts 
of  the  body,  while  in  colon  disorders  these  symptoms 
are  wanting  after  the  bloating  has  been  relieved.  These 
rules,  of  course,  apply  only  to  the  early  stages  of  the 
affection.  An  impaction  at  the  sternal  flexure  may  give 
rise  to  these  stomach  symptoms,  but  the  differentiation  is 


SURGICAL  TREATMENT  OF  COLICS  77 

soon  made  when  stomach  cathetrization  fails  to  afford 
relief,  and  then  there  is  always  the  rectal  exploration 
upon  which  we  can  depend  to  make  an  accurate  diag- 
nosis of  the  exact  seat  of  the  obstruction  in  almost  all 
instances. 

The  disorders  of  the  large  bowels  in  which  surgery 
plays  an  important  role  are: 

Acute  Intestinal  Indigestion 

This  is  sometimes,  although  by  no  means  always,  as- 
sociated with  acute  indigestion  in  the  stomach.  This  con- 
dition is  the  flatulent  colic  of  the  old  school  veterinarians. 

Symptoms. — The  bowels  are  overwhelmed  with 
food  or  with  tainted  food.  The  formation  of  gases  from 
fermentation  is  sometimes  so  rapid  as  to  cause  death 
in  short  order  if  relief  is  not  promptly  given  and  often 
the  damage  done  to  the  intestinal  walls  by  the  stretching 
produces  a  condition  in  the  colon  analogous  to  the  dila- 
tion of  the  stomach  previously  described. 

The  exhausted  muscularis,  being  unable  to  contract, 
fails  to  move  the  accumulated  mass.  Very  often,  I  re- 
gret to  say,  this  state  of  exhaustion  is  aggravated,  if 
not  actually  caused,  by  the  administration  of  eserine  or 
arecoline.  These  drugs  tax  the  muscularis  severely,  by 
causing  futile  contraction  against  the  solid  contents, 
and  thus  leave  the  bowel  helpless,  vapid,  paralyzed  at 
a  crucial  period  of  the  disease  when  even  a  little  peris- 
talsis would  be  mighty  valuable. 

Treatment.— The  simple  operation  of  intestinal 
puncture,  enterocentesis,  as  we  have  been  prone  to  call 
it,  is  the  cherished  bit  of  colic  surgery  that  must  be  de- 
pended upon  as  the  curative  expedient.     It  is  strictly  a 


78  COLICS  AND  THEIR  TREATMENT 

veterinarian's  operation,  very  old  and  very  simple,  but 
no  less  valuable  because  of  this.  The  total  value  of  horses 
saved  by  this  simple  operation  would  be  well  worth  re- 
cording. When  this  operation  has  been  done,  appro- 
priate medical  treatment  per  os  must  follow.  Analgesics  ? 
No.  Cannabis  indica,  chloral,  opiates  are  just  so  many 
harmful  agents  that  should  have  no  place  in  the  treat- 
ment of  this  condition,  or,  in  fact,  in  the  treatment  of 
any  form  of  colic  for  that  matter. 

During  the  past  few  years  I  have  followed,  with  won- 
derful success,  the  treatment  of  the  late  Dr.  N.  P.  Whit- 
more,  of  Illinois,  which  consists  of  the  administration 
of  ether  in  large  doses.  Whitmore  would  administer  to 
his  patients,  sick  with  acute  indigestion,  gastric  or  intes- 
tinal, a  full  half-pint  of  ether  as  a  drench.  I  have  been 
told  on  good  authority  that  he  sometimes  drenched  a 
horse  with  one-half  pint  and  even  a  full  pint  of  ether 
from  the  original  package  without  dilution.  This  we 
have  modified  to  six  ounces  given  with  linseed  oil.  The 
effect  of  ether  vapor  upon  intestinal  fermentation  is  phe- 
nomenal, when  given  in  large  doses. 

A  purgative  of  aloin  or  aloes  given  as  soon  as  the  acute 
symptoms  have  passed,  will  act  as  a  stimulant  to  the  colon 
some  hours  later,  at  a  time  such  stimulation  is  needed  to 
prevent  obstipation. 

Impaction  of  the  Colon 

The  second  disorder  of  the  large  bowels  is  impaction 
of  the  colon — a  condition  consisting  of  the  accumulation 
of  more  or  less  solid  masses  of  aliment  throughout  or 
at  different  points  of  this  large  folded  compartment.    It 


SURGICAL  TREATMENT  OF  COLICS  79 

may  follow  acute  intestinal  indigestion  or  may  arrive  as 
an  initial  condition.  Where  horses  are  fed  largely  upon 
dry  fodder  for  months,  it  is  very  common  and  horses 
worked  hard  and  fed  well  to  keep  up  their  condition 
are  also  very  susceptible.  In  hard-worked  city  horses 
it  often  follows  periods  of  idleness  where  the  ration  has 
not  been  reduced,  and  horses  idle  from  some  locomo- 
tory  disability  may  fall  victims  while  unable  to  take  suffi- 
cient exercise  to  keep  up  the  intestinal  activity. 

Pathologically,  impaction  of  the  colon,  as  seen  in 
horses,  is  a  partial  or  complete  paralysis  of  the  walls 
of  the  colon.  The  word  "paralysis"  applies  best  to  this 
condition  because  the  muscularis  after  being  overwhelmed 
into  a  state  of  enfeeblement,  fails  to  contract. 

Symptoms. — The  symptoms  are  quite  character- 
istic. Indeed,  there  is  little  excuse  for  not  making  an 
early  diagnosis  in  every  case.  The  pain  is  mild  and  at 
first  intermittent.  The  right  flank,  compared  carefully 
with  the  left,  is  slightly  bulged  and  sometimes  bloated. 
During  the  first  hour  or  two  the  feces  are  voided  fre- 
quently in  small  quantities,  but  this  ceases  as  soon  as  the 
floating  colon  is  empty.  On  auscultation  of  the  right 
flank  the  borborygmus  is  found  feeble  or  absent,  and  on 
exploration  per  rectum  there  is  little  trouble  found  in  lo- 
cating the  solid  contents  of  the  colon. 

When  the  pain  is  more  acute  the  patient  may  sit  dog- 
fashion  or  at  times  stretch  out  as  a  male  does  in  the  act 
of  urination.  The  absorption  of  toxic  products  may  cause 
some  elevation  of  temperature,  in  rare  cases,  early  in  the 
course  of  the  disease,  but  more  often  there  is  but  little 
rise  in  the  body  temperature  until  the  patient  is  in  a 


80  COLICS  AND  THEIR  TREATMENT 

hopeless  condition.  I  always  interpret  fever  with  colonic 
impactions  as  an  exceedingly  grave  symptom. 

Treatment. — When  impaction  of  the  colon  is 
found  to  exist,  no  time  must  be  lost  in  waiting  for  the 
action  of  slow-acting  purgatives.  On  the  other  hand 
powerful  drugs  that  act  as  transient  stimulants  to  the 
muscularis  are  exceedingly  harmful.  A  horse  affected 
with  a  formidable  impaction  of  the  colon  that  survives  a 
dose  of  eserine,  survives  in  spite  of  the  treatment  and  not 
through  it.  Linseed  oil  and  also  aloes  are  probably  the 
best  drugs  for  this  condition,  but  are  useless  in  serious 
cases  because  there  are  no  contractions  of  the  muscularis 
to  distribute  them  to,  and  through,  the  accumulated  mass, 
and  as  for  eserine  I  am  certain  it  is  only  helpful  in 
cases  which  would  have  recovered  without  medication. 
The  walls  are  too  weak  to  cope  with  the  heavy,  dry, 
voluminous  mass  impacted  within  them  and  a  transient 
stimulation,  such  as  is  produced  by  eserine  or  arecoline, 
only  adds  to  the  enfeeblement,  by  impelling  futile  con- 
tractions. 

We  are  now  using  for  this  condition  three  forms  of 
direct  treatment,  as  follows : 

1.  Colonic  Flushing  Per  Rectum. — High  enemas. 
While  we  have  not  entirely  overcome  the  difficulties  at- 
tending attempts  to  wash  out  the  large  colon  of  horses, 
we  are  becoming  more  and  more  successful  in  injecting 
large  volumes  of  water  into  it. 

We  admit  there  is  no  easy  method  of  washing  out  the 
colon.  The  long  floating  colon  of  the  herbiverous  animals 
stands  as  a  real  obstacle  against  the  instillation  of  water 
into  the  larger  compartment  anterior  to  it,  and  since  the 


SURGICAL  TREATMENT  OF  COLICS  81 

veterinarian  is  thus  deprived  of  a  highly  effectual  cura- 
tive expediment,  any  manipulation  that  will  surmount 
this  obstacle  would  be  an  invaluable  addition  to  the  treat- 
ment of  many  grave  disorders. 

We  need  colonic  flushing  in  animal  therapy  and  we 
need  it  badly.  Fatalities  amongst  animals,  sick  with  di- 
gestive disorders,  would  be  greatly  reduced  if  we  could 
inject  water  into  the  colon  of  herbivora,  as  easily  as  into 
that  of  the  carnivora  and  of  humans.  Overcoming  im- 
pactions of  the  colon  would  then  be  a  triviality. 

Our  method  of  forcing  water  into  the  colon  is  not 
perfect.  We  are  still  in  need  of  a  better  instrument  to 
prevent  reflux  from  straining,  but  we  have  shown  to  our 
entire  satisfaction  that  by  patiently  forcing  water  at  a 
temperature  of  112°  F.  into  the  floating  colon  by  means 
of  a  hose  and  pump  with  the  rectum  packed  with  some 
substance  to  prevent  free  reflux  of  the  water,  large  quan- 
tities can  be  passed  into  the  colon.  While  the  floating 
colon  is  still  full  of  feces  not  much  headway  can  be 
made,  but  when  this  is  expelled  a  stream  may  be  made 
to  flow  forward  through  this  gut  and  into  the  large  colon. 
Straining  to  expel  the  water  injected  cannot  be  entirely 
controlled,  but  we  have  found  that  since  all  the  water 
injected  is  not  successfully  expelled  by  the  patient  in 
these  seizures,  some  will  find  its  way  into  the  colon  if 
the  operation  is  persistently  continued. 

We  have  found  also  that  an  animal  narcotized  with 
drugs  administered  hypodermically  or  anesthetized  with 
chloroform  will  take  large  volumes  of  water  by  a  little 
patient  forcing,  and  also  that  water  at  the  proper  tem- 
perature, not  too  hot  nor  too  cold,  is  less  apt  to  cause 


82 


COLICS  AND  THEIR  TREATMENT 


straining.  We  once  ruptured  a  horse's  floating  colon  by 
applying  too  much  force  to  the  pump,  an  occurrence  that 
shows  the  operation  is  not  without  its  hazards. 

Our  method  in  use  today,  but  which  we  hope  to  im- 
prove when  we  have  finally  invented  the  proper  instru- 
ment, is  as  follows : 

A  hose  is  passed  into  the  floating  colon  as  far  as  pos- 
sible and  then  the  rectum  is  packed  with  cotton  wads 
until  it  is  full.  Expulsion  of  the  cotton  is  prevented  by 
holding  the  hand  firmly  against  it  within  the  anus.  Then 
hot  water,  previously  prepared,  in  abundance,  is  pumped 
into  the  horse  until  straining  is  produced.  As  soon  as 
the  straining  paroxysm  ceases  the  pumping  is  resumed. 
At  first  only  a  small  quantity  may  be  retained,  but  if  the 
operation  is  persistently  repeated  large  quantities  will 
eventually  find  its  way  forward.  The  operation  is  a 
mussy  affair,  I  admit,  but  is  the  no  less  valuable  on  this 
account. 

The  Kellogg  rectal  lock  syringe,  which  contains  an  in- 
flated rubber  bulb  to  prevent  reflux,  is  probably  an  im- 
provement over  this  more  crude  mechanism  of  ours,  but 
it,  too,  must  be  held  in  with  the  hands  and  the  reflex  is 
by  no  means  controlled  by  it.  There  is  need  of  a  hose 
having  an  inflatable  bulb  as  large  as  a  football  that  is  so 
arranged  that  it  can  be  retained  in  the  rectum  by  means 
of  a  harness.  We  are  having  such  an  affair  constructed, 
but  since  it  has  not  been  completed  we  cannot,  of  course, 
venture  any  opinion  as  to  its  merits  at  this  time. 

2.  Instillation  of  Water  Into  the  Stomach.— -The 
second  operation  we  use  against  impactions  of  the  colon 
is  the  instillation  of  copious  drafts  of  water  into  the  in- 


SURGICAL  TREATMENT  OF  COLICS  83 

testines  through  the  stomach  with  the  stomach  tube.  If 
the  stomach  is  full,  but  this  is  seldom  the  case,  it  should 
first  be  washed  out  and  then  six  to  eight  gallons  of  water 
injected  into  it.  The  water  promptly  finds  its  way  into 
the  intestinal  tract,  sometimes  as  far  as  the  cecum.  By 
supplying  the  intestines  with  these  liberal  draughts  of 
water  from  two  directions,  there  are,  indeed,  few  cases 
of  impactions  that  will  not  yield,  when  the  diagnosis  is 
made  before  the  muscularis  has  been  too  seriously  weak- 
ened and  a  peritonitis  has  already  developed. 

3.  Flushing  the  Colon  Through  the  Abdominal  Wall. 
— The  third  is  the  direct  instillation  of  water  or  oil  into 
the  colon  through  the  abdominal  wall  by  means  of  a 
trocar  and  canula.  The  right  flank  is  punctured  in  the 
usual  manner  and  after  the  trocar  is  removed  a  small 
rubber  hose  is  attached  to  the  canula  and  the  instillation 
done  by  pouring  the  liquid  into  the  funnel  attached  to 
the  other  end.  The  intestines  will  slowly  take  liberal 
amounts  of  fluids  in  this  manner.  The  procedure  is 
harmless,  and,  if  done  at  an  early  stage,  is  very  effectual. 

When  the  contents  are  known  to  have  been  softened 
by  these  methods,  eserine  may  be  given  with  safety  and 
with  splendid  results. 

I  am  aware  that  these  systems  of  attacking  impactions 
are  not  new.  They  have,  however,  never  become  stand- 
ard operations,  and,  in  view  of  the  fact  that  they  are 
proving  phenomenal  in  the  hands  of  those  who  have  be- 
come expert  in  the  essential  manipulations,  this  atten- 
tion to  them  has  been  deemed  worth  while. 
Torsion  of  the  Colon 

Torsion  of  the  colon  is  a  common  enough  accident  of 
horses,  and,  of  course,  always  fatal.     Attempts  to  cor- 


84  COLICS  AND  THEIR  TREATMENT 

rect  the  displacement  by  manipulations  have  never  been 
successful.  Some  have  told  us  that  this  may  be  done  by 
rolling  the  patient  while  the  arm  is  held  in  the  rectum. 
At  my  hands  this  has  always  failed.  Direct  handling  of 
the  organ  through  a  flank  laparotomy  has  likewise  been 
an  unsuccessful  procedure  with  me.  I  have  always  found 
the  colon  too  weak  to  stand  the  traction  required  to  lift 
it  with  its  heavy  contents.  Latterly  the  procedure  of  Doc- 
tor Hartwig  of  Wisconsin  for  torsion  of  the  uterus  of 
cows  has  occurred  to  me  to  be  applicable  to  the  colon 
as  well.  Unfortunately,  I  have  not  met  a  case  since 
Hartwig  announced  his  method  publicly,  but  believe  we 
now  have  a  method  of  untwisting  a  colon  without  much 
trouble.  The  success,  of  course,  will  depend  upon  a 
diagnosis  being  made  before  the  organ  is  damaged  by 
disease. 

Hartwig  has  performed  some  operations  for  torsion 
of  the  uterus  in  cows  with  splendid  success,  by  making 
an  abdominal  section  in  the  right  flank  large  enough  to 
admit  both  arms.  In  this  I  see  the  secret  of  success  in 
handling  the  twisted  colon,  for  with  both  hands  the  organ 
can  be  lifted  without  danger  of  tearing  its  walls. 

In  conclusion,  I  venture  to  say  that  the  possibilities 
of  successful  instrumentation  of  the  intestinal  tract  and 
stomach  of  animals  are  by  no  means  meager.  Although 
the  operations  are  of  a  different  order  than  those  splen- 
did invasions  of  the  human  surgeons,  we  have  a  broad 
field,  that  we  have  thus  far  failed  to  cultivate  as  fruit- 
fully as  is  possible,  and  from  which  may  be  selected  a 
wealth  of  operations  that  will  cure  colics  heretofore  re- 
garded as  fatal. 


Impaction  of  the  Cecum  in 
the  Horse* 

By  A.  T.  Gilyard,  D.  V.  M.,  Waterbury,  Conn. 

The  subject  of  Cecal  Impaction  is  one  upon  which 
there  seems  to  have  been  little  written.  To  the  best  of 
my  knowledge  the  first  description  of  this  condition  was 
written  by  Prof.  Grofton,  of  the  Royal  (Dick)  Veterinary 
College,  Edinburgh,  and  published  in  the  May  11,  1912, 
edition  of  The  Veterinary  Record.^  In  this  article  Prof. 
Gofton  gives  a  very  fine  and  complete  description  of 
four  cases  of  subacute  obstruction  of  the  cecum,  which 
fully  establishes  that  as  a  distinct  form  of  colic  of  the 
equine. 

The  next  literature  on  the  subject  is  from  the  pen  of 
the  well-known  colic  specialist,  H.  Caulton  Reeks,  F.  R. 
C.  V.  S.,  and  was  published  in  January,  1913.  In  this 
paper  the  subject  is  dealt  with  in  that  most  thorough  and 
comprehensive  manner,  characteristic  of  all  of  the  valu- 
able writings  of  Mr.  Reeks,  on  the  common  colics  of  the 
horse.  Mr.  Reeks  describes  one  additional  case  of  this 
trouble  and  advances  some  very  plausible  theories. 

I  have  met  with  two  cases  of  impaction  of  the  cecum 
in  the  horse.     Strange  to  say,  these  two  cases  of  this  ap- 

"iteid    at    semi-annual    meeting    of    the    Connecticut    Veterinary    Medical 
Association,  Waterbury,   August,   1913. 

&***.      ThPe  nef  ~^f  ^f^^,"^    Wn    ££& 

b'y  SS'r°SnMc£Ven,  SZ.  SpS!  Brown  and  Reeks,  all  of  England.- 
Editor. 


86  COLICS  AND  THEIR  TREATMENT 

parently  rare  disease,  occurred  within  a  month,  and  con- 
sequently impressed  me  quite  strongly. 

I  must  confess  that  during  the  lives  of  the  patients  I 
did  not  locate  the  exact  portion  of  large  intestine  af- 
fected; and  thought  both  cases  to  be  impaction  of  the 
great  colon,  but  realized  that  they  were  atypical.  Fortu- 
nately, owing  to  certain  extraordinary  manifestations,  I 
conducted  thorough  postmortem  examinations  in  both 
cases,  the  results  of  which  amply  repaid  me  for  the 
time  and  labor  involved. 

My  observations  during  life  and  after  death  in  these 
two  cases  will,  I  feel  positive,  enable  me  to  make  an 
early  diagnosis,  should  I  again  meet  with  one  of  these 
cases.  As  an  excuse  for  my  failure  to  differentiate  cecal 
from  colonic  impaction,  I  will  say,  that,  while  handling 
the  first  I  was  unaware  of  the  possibility  of  impaction  of 
the  cecum,  and  in  the  second  case  I  formed  a  strong 
impression  that  the  unusually  long  duration  of  the  im- 
paction was  due  to  adhesions  or  deformities  of  the  colon, 
and  failed  to  give  weight  to  symptoms  which  I  now 
recall. 

The  symptoms  in  my  cases  differ  in  some  minor  de- 
tails from  those  in  the  cases  chronicled  by  the  above 
writers.  I  will  describe  the  course  of  the  disease  as  I 
have  seen  it,  and  attempt  to  draw  conclusions. 

A  Case  of  Cecal  Impaction  Fatal  in  Six  Days 
Unfortunately  I  did  not  see  the  first  case  until  eight 
hours  before  death  which  took  place  on  the  sixth  day 
after  the  onset  of  the  attack.  Consequently  part  of  this 
description  is  history  which  by  much  questioning  I  have 
tried  to  make  complete  in  the  important  points. 


IMPACTION  OF  THE  CECUM  87 

The  subject  was  a  sturdy  gelding,  one  of  a  farm  team, 
weight  about  1,300  pounds,  age  eight  years.  This  team 
was  subjected  to  hard  work  and  irregular,  heavy  feed- 
ing on  grain;  they  were  rarely  watered  between  the 
evening  and  morning  meals.  The  owner  wished  water 
given  during  the  evening,  but  as  is  too  often  the  case 
this  was  neglected.  Relative  to  the  system  of  watering, 
I  will  insert  an  excerpt  from  Prof.  Gofton's  writings 
on  this  subject. 
He  says: 

"I  attributed  my  cases  of  cecal  impaction  to  one  of 
two  causes,  but  I  am  not  able  to  assess  the  relative  im- 
portance of  each  nor  to  say  how  far  they  acted  con- 
jointly. 

"Colic  cases  were  of  great  frequency  in  this  particular 
stable,  and  they  all  ceased  suddenly,  their  cessation  co- 
inciding with  the  simultaneous  removal  of  what  I  con- 
sidered the  causal  factors  in  operation.  The  first  was 
the  system  of  watering.  All  of  the  horses  were  watered 
when  they  returned  from  work  at  night,  and  before  feed- 
ing. From  then  until  they  turned  out  to  work  on  the 
following  morning  they  had  no  drink  of  any  kind.  This 
was  altered  by  giving  the  horses  the  offer  of  a  drink 
after  feeding  at  night  and  before  feeding  in  the  morn- 
ing, in  addition  to  the  existing  arrangements. 

"Secondly,  molassine  meal  was  mixed  with  the  food 
when  prepared. 

"Food  sufficient  to  serve  three  to  seven  days  was  pre- 
pared at  one  time. 

"I  think  the  damp  molassine  lying  in  the  dry  feed  for 


88  COLICS  AND  THEIR  TREATMENT 

three  to  seven  days  injuriously  affected  it.  This  was 
altered  by  feeding  the  molassine  with  each  meal  instead 
of  mixing  it  and  allowing  it  to  lie  for  days  with  the  dry 
food." 

It  is  interesting  to  note  that  one  of  these  contributing 
causes,  namely,  the  absence  of  water  between  the  evening 
and  morning  meals,  was  present  in  the  case  under  con- 
sideration. Also,  the  exciting  cause  in  this  case  may  be 
likened  to  the  second  contributing  cause  cited  by  Prof. 
Gofton,  in  that  it  was  such  as  to  bring  about  fermenta- 
tion in  the  alimentary  tract,  as  will  be  seen  by  the  fol- 
lowing. 

History  and  Symptoms. — On  the  afternoon  of  Sat- 
urday, June  8th,  a  large  quantity  of  green  rye  was 
mowed  and  given  to  this  pair  of  horses.  In  a  few  hours 
both  were  showing  distressing  symptoms  of  acute  indi- 
gestion, with  both  gastric  and  intestinal  flatulence  and 
quite  violent  pain. 

A  veterinarian  who  was  immediately  called  to  treat 
the  animals  administered  arecoline  and  resorted  to  punc- 
ture of  the  intestine  in  both  cases.  The  mate  growing 
rapidly  worse,  regurgitating  gas  and  fluid  from  the  stom- 
ach, and  suffering  again  from  intestinal  flatulence  which 
could  not  be  relieved  by  the  trocar ;  died  late  that  evening. 

Our  subject  improved,  it  was  said,  and  after  the  pas- 
sage of  considerable  feces  and  flatus  the  pain  seemed  to 
stop.  The  attending  veterinarian  administered  a  quart 
of  linseed  oil,  and  believing  the  animal  to  be  out  of 
danger,  dismissed  the  case. 

On  Sunday,  June  9th,  purgation  from  the  oil  occurred, 
there  was  evidence  of   intermittent  dull  pain,  but  the 


IMPACTION  OF  THE  CECUM  89 

horse  ate  some  bran  and  hay  and  drank  a  bucket  of 
water  during  the  intervals  of  rest. 

The  presence  of  abdominal  pain  was  shown  by  the 
animal's  lying  at  full  length  on  the  left  side  and  oc- 
casionally lifting  the  head  to  the  right  flank.  The  signs 
of  suffering  were  "so  slight  and  the  horse  appeared  so 
well  during  the  intervals  that  the  owner  did  not  con- 
sider the  condition  at  all  serious,  and  attributing  the  pain 
to  the  action  of  the  oil,  did  not  call  a  veterinarian. 

On  Monday,  June  10th,  the  periods  of  dull  pain  and 
the  intervals  of  apparent  ease,  were  about  the  same  as 
on  the  preceding  day.  The  appetite  was  more  vigorous 
and  there  were  two  practically  normal  bowel  movements. 
More  water  was  taken  and  urination  was  said  to  be  fre- 
quent and  again  professional  advice  was  not  sought. 

On  Tuesday,  June  11th,  the  only  change  noted  was  in 
the  appearance  of  the  urine,  which  was  described  as  thick 
and  cloudy,  being  voided  frequently,  in  small  quantities. 

On  the  morning  of  Wednesday,  June  12th,  the  horse 
showed  evidence  of  having  suffered  more  acutely  during 
the  night.  The  head,  heels  and  hips  were  badly  bruised. 
The  periods  of  pain  were  of  longer  duration  and  the  in- 
tervals of  rest  were  shorter.  There  was  considerable 
straining  to  micturate,  but  the  appetite  was  not  entirely 
absent. 

Another  veterinarian  was  called,  who,  after  having  ad- 
ministered a  hypodermic  purgative,  from  the  action  of 
which  there  resulted  quite  a  free  passage  from  the 
bowels,  left  a  stimulant  and  arranged  to  call  again  on 
the  following  day. 

On   Thursday,   June    13th,   there   was   less   pain   and 


90  COLICS  AND  THEIR  TREATMENT 

more  appetite  than  on  Wednesday.  The  attending  veter- 
inarian found  sensitiveness  in  the  region  of  the  bladder 
on  rectal  exploration  and  as  the  urine  was  very  cloudy, 
prescribed  a  refrigerant  and  alkaline  diuretic. 

Palpation  of  the  bladder  seems  to  have  produced  so 
much  straining  that  further  exploration  was  impossible. 

On  Friday,  June  14th,  I  saw  the  case  for  the  first  time. 
On  being  hurriedly  summoned,  at  8 :30  a.  m.,  I  found 
the  horse  in  a  serious  condition.  The  owner  said  that 
there  had  been  a  decided  change  for  the  worse  during 
the  last  two  hours  previous  to  my  arrival.  The  symp- 
toms were  very  puzzling,  the  pain  was  then  of  the  type 
which  causes  the  horse  to  step  quickly  back  and  forth, 
looking  anxiously  to  one  flank  and  then  the  other,  crouch 
as  if  to  lie  down,  then  straighten  up  and  paw.  The  res- 
piration was  of  the  "puffy"  type.  There  was  patchy 
perspiration,  but  still  the  pulse  was  fairly  soft  and  smooth 
at  sixty  per  minute  and  the  general  circulation  seemed 
good  with  no  chilling  of  the  extremities. 

As  neither  the  history  nor  the  external  manifestations 
enabled  me  to  make  a  diagnosis,  I  then  proceeded  with  a 
thorough  rectal  exploration  which  soon  revealed,  to  a 
certain  extent,  the  nature  of  the  trouble.  The  rectum 
was  empty  and  dry,  the  intestines  in  the  pelvic  region 
were  flacid,  on  advancing  to  the  right  flank  region  the 
hand  encountered  a  very  severely  impacted  large  intes- 
tine, which  was  sensitive  to  palpation.  The  posterior 
and  lateral  faces  of  this  bowel,  as  far  as  could  be  reached, 
were  irregularly  rounded. 

Superiorly  the  viscous  seemed  to  be  attached  to  the 
roof  of  the  abdomen  in  the  sub-lumbar  region. 


IMPACTION  OF  THE  CECUM  91 

Diagnosis. — Judging  from  the  form,  location  and  at- 
tachments of  this  obstructed  portion  of  intestine,  I  im- 
mediately mistook  it  for  the  voluminous  extremity  of 
the  great  colon  which  so  suddenly  draws  in  to  join  the 
anterior  extremity  of  the  small  colon.  Often  having 
found  this  part  of  the  great  colon  impacted  I  thought  it 
nothing  out  of  the  ordinary. 

In  view  of  the  sensitiveness  on  palpation  and  the  long 
duration  of  the  attack  and  the  seriousness  of  the  general 
condition,  I  considered  the  outcome  quite  doubtful  and 
so  informed  the  owner. 

However,  as  the  owner  believed  very  strongly  in  the 
old  adage,  "Where  there  is  life  there  is  hope,"  he  in- 
sisted that  I  give  treatment. 

Treatment.— The  stomach  tube  was  passed  and  af- 
ter having  emptied  the  stomach  of  two  or  three  gallons 
of  fluid  in  which  floated  a  small  quantity  of  food,  we 
pumped  in  three  gallons  of  warm  water  in  which  had 
been  dissolved  24  ounces  of  magnesium  sulphate  and 
eight  ounces  of  sodium  chloride. 

After  having  withdrawn  the  tube  I  administered  a 
regulation  aloetic  cathartic  bolus  and  left  mix  vomica  to 
be  given  every  four  hours. 

The  foregoing  has  been,  for  the  past  two  years,  by 
never  failing  treatment  for  subacute  impaction  of  the 
colon,  when  the  cases  have  been  seen  at  a  reasonably 
early  date. 

At  4  p.  m.  the  owner  again  phoned  that  he  wished  me 
to  come  immediately ;  on  my  arrival  I  found  that  a  de- 
cided change  had  taken  place  since  the  morning.  The 
horse  was  covered  with  perspiration,  the  pulse  at  the 


92  COLICS  AND  THEIR  TREATMENT 

jaw  could  not  be  counted  and  the  artery  felt  like  a  small 
hard  cord.  The  extremities  were  cold  and  the  shoulder 
muscles  were  in  a  constant  tremor.  Per  rectum  I  de- 
tected the  presence  of  ingesta  floating  free  in  the  peri- 
toneal cavity,  this  I  attributed  to  intestinal  rupture  and 
told  the  owner  that  the  horse  must  surely  die  in  a  very 
few  hours. 

I  then  made  arrangements  to  hold  an  autopsy  the 
next  day  at  six  a.  m.  Soon  after  my  departure  the 
owner  had  the  animal  led  to  a  field,  where  he  died  after 
about  an  hour's  suffering. 

Post  Mortem  Findings. — At  the  autopsy  I  was 
surprised  to  find  the  cecum,  instead  of  the  colon,  im- 
pacted and  ruptured,  its  walls  were  darkened  and  easily 
torn. 

The  remainder  of  the  intestinal  tract  was  practically 
empty  save  for  a  small  quantity  of  ingesta  the  consistency 
of  pea  soup. 

Attack  of  Cecal  Impaction  of  Seventeen  Days'  Dura- 
tion 

My  second  case  occurred  in  a  twenty-year-old  mare 
weighing  about  900  pounds.  This  mare  was  one  of  a 
stable  of  nine  horses,  used  for  delivery  purposes,  by  a 
grocery  firm. 

These  horses  were  fed  oats,  bran  and  hay,  and  were 
allowed  water  when  brought  in  from  work  just  before 
the  evening  meal,  but  received  no  more  until  after  break- 
fast when  harnessed  for  the  day's  work. 

On  the  morning  of  July  1st  this  mare  and  an  old 
gelding  from  the  same  stable  were  driven  to  the  hos- 


IMPACTION  OF  THE  CECUM  93 

pital  within  an  hour  of  each  other,  both  showing  symp- 
toms of  colic. 

By  auscultation  and  percussion  of  the  flanks  I  de- 
termined the  presence  of  an  excess  of  gas  in  the  in- 
testines. This  acute  fermentative  indigestion  I  attrib- 
uted to  faulty  food. 

Each  horse  received,  subcutaneously,  one  grain  of 
physostigmine  salicylate  and  orally  a  capsule  of  betanaph- 
thol  and  powdered  nux  vomica  and  both  were  sent 
home  to  be  placed  in  box  stalls  and  await  results. 

After  about  two  hours  I  made  a  visit  and  found  that 
in  both  cases  the  eserine  had  caused  the  evacuation  of 
large  quantities  of  feces  and  flatus,  but  the  pain  still  per- 
sisted although  it  was  not  as  severe  as  while  purgation 
was  taking  place. 

When  I  again  saw  the  cases  in  the  afternoon  both 
were  still  uneasy  and  I  had  them  taken  to  the  hospital. 

The  gelding  soon  eased  up  after  the  walk  from  the 
stable  but  the  mare  continued  in  dull  pain,  with  pulse 
full  and  soft  at  forty  per  minute;  respiration  slow,  but 
slightly  labored,  and  temperature  normal.  In  the  even- 
ing, per  rectum,  I  discovered,  in  the  right  sublumbar 
region  an  impacted  intestine,  large,  round  and  very  hard, 
and  seemingly  attached  superiorly. 

This  I  took  to  be  the  last  portion  of  the  colon  and 
confidently  administered  the  magnesium  sulphate  and 
sodium  chloride  treatment  through  the  stomach  tube  and 
followed  this  with  an  aloetic  pill. 

During  the  following  day,  July  2nd,  there  were  sev- 
eral watery  evacuations  accompanied  by  some  pain, 
which  I  attributed  to  the  purgatives.    As  there  was  some 


94  COLICS  AND  THEIR  TREATMENT 

appetite  for  hay  and  water  I  gave  the  case  little  atten- 
tion. 

On  July  3d  the  dull  pain  continued  although  the  mare 
ate  some  bran  and  hay  and  drank  a  pail  of  water. 

I  made  a  rectal  exploration  to  determine  the  cause  of 
the  pain  and  found  the  impacted  intestine  apparently  un- 
changed since  July  1st  and  was  sorely  puzzled.  I  re- 
peated the  treatment  given  on  the  first  evening.  On  the 
next  day,  July  4th,  the  mare  again  purged  and  the  stools 
contained  a  few  whole  oats,  but  the  impaction  was  not 
perceptibly  changed. 

From  the  first  until  the  seventeenth  of  July  I  tried, 
except  laparotomy,  every  means  within  my  knowledge 
to  remove  that  impaction,  all  to  no  avail. 

I  used  eserine,  arecoline,  barium  chloride,  aloes,  aloin, 
magnesium  sulphate,  sodium  chloride,  linseed  oil,  etc., 
augmented  by  large  quantities  of  water  by  the  stomach 
tube  and  by  rectal  injection,  both  hot  and  cold.  In  the 
application  of  the  rectal  injections  I  sometimes  attached 
the  tube  to  the  city  water  and  continued  it  for  hours; 
this,  I  think,  gave  better  results  than  anything  else  used, 
sometimes  bringing  away  quite  a  quantity  of  whole  oats, 
none  of  which  had  been  ingested  since  the  beginning  of 
the  attack. 

During  these  seventeen  days  I  continued  stimulation 
in  the  form  of  strychnine  and  powdered  nux  vomica, 
twice  I  pushed  the  latter  to  the  limit,  once  until  the 
mare  was  unable  to  gain  her.  feet  for  a  period  of  four 
hours. 

On  the  evening  of  July  17th  the  mare  seemed  to  be  in 
about  the  same  condition  as  she  had  been  since  July  1st, 


IMPACTION  OF  THE  CECUM  95 

but  on  the  following  morning  she  was  much  worse,  in 
great  distress,  labored  breathing,  rapid  wiry  pulse  and 
patchy  perspiration. 

Per  rectum  I  discovered  the  presence  of  ingesta  in  the 
peritoneal  cavity,  denoting  a  rupture;  whereupon  I  shot 
the  poor  creature.  The  postmortem  examination  showed 
the  cecum  to  be  full  of  almost  dry  closely  packed  in- 
gesta with  an  eight-inch  rent  near  its  base. 

The  remainder  of  the  intestinal  tract  was  practically 
empty. 

Theory  As  to  the  Cause  of  Cecal  Impaction 

From  my  observations  in  these  two  cases  I  firmly  be- 
lieve that  impaction  of  the  cecum  is  caused,  primarily 
and  fundamentally  by  the  lack  of  water  in  sufficient 
quantities  and  at  the  proper  time  to  keep  this  reservoir  of 
the  system  filled  with  fluids. 

We  know  that  horses  coming  from  work  at  night  and 
expecting  food,  will  not,  as  a  rule,  drink  water  in  very 
great  amount  until  this  appetite  for  food  has  been  sat- 
isfied. We  know  that  horses  will  drink  eagerly  and  at 
length  if  water  is  offered  them  two  or  three  hours  after 
the  evening  meal.  Many  times  we  have  seen  a  horse  stop 
eating  hay  during  the  evening  and  refuse  to  eat  more 
until  after  having  had  water. 

Physiologists  agree  that  the  contents  of  the  cecum  are 
always  fluid  or  of  the  consistency  of  pea  soup.  I  know 
that  I  have  at  postmortem  examinations,  except  in  these 
two  cases,  always  found  this  to  be  true. 

I  think  that  Fred  Smith,  in  his  work  on  Physiology, 
hits  upon  a  most  plausible  theory,  when  he  suggests  that 
the   ingesta   may   pass   directly   from   the   ileum   to  the 


96  COLICS  AND  THEIR  TREATMENT 

colon  without  entering  the  cecum.  To  accomplish  this, 
the  firm  muscular  nozzle  like  extremity  of  the  ileum 
would  have  to  be  carried  upwards  and  into  the  entrance 
of  the  colon,  there  to  discharge  its  solid  contents. 

I  will  go  one  step  farther  and  suggest  that  if  the  above 
be  true,  and  I  have  reason  to  believe  that  it  is,  may 
not  this  muscular  extremity  of  the  ileum,  or  so-called 
ileo-cecal  valve,  possess  a  selective  power  on  solids, 
semisolids  and  fluids  similar  to  that  of  the  esophageal 
pillars  of  ruminants? 

This  would  enable  the  ileum  to  discharge  its  coarse, 
practically  indigestible  solids  directly  into  the  colon  and 
its  fluids  containing  the  great  majority  of  the  soluble 
and  diffusible  matter  into  the  cecum  where  it  could  be 
quickly  taken  up  by  the  blood. 

Presuming  this  to  be  possible  we  may  assume  that  in 
the  absence  of  water  in  sufficient  quantities  to  keep  the 
cecum  at  its  normal  status  of  distention,  collapse  of  its 
walls  would  occur  and  disturbance  of  this  presumed  se- 
lective power  of  the  ileco-cecal  valve  might  result  and 
solids  be  discharged  into  the  cecum  until  this  reservoir 
became  distended. 

Following  this,  whatever  diffusable  fluids  were  mixed 
with  these  solids  would  be  quickly  taken  into  the  blood 
in  the  natural  way  and  a  firm  dry  impaction  of  the  cecum 
would  be  the  result. 

The  very  form  of  the  cecum,  with  its  outlet  close  to 
and  higher  than  its  inlet,  makes  it  impossible  for  this 
organ  to  get  rid  of  a  large  solid  mass,  in  any  manner 
that  I  can  at  present  conceive  of. 

When  we  have  an  impaction  of  an  intestine  through 


IMPACTION  OF  THE  CECUM 


97 


which  the  ingesta  pass  as  through  a  tube  and  are  carried 
along  by  the  perstaltic  movements  of  the  bowel  walls,  the 
proposition  is  entirely  different.  In  a  case  of  this  kind 
it  is  easy  to  see  that  fluids  taken  by  mouth  or  secreted 
by  the  intestines  would  be  carried  along  to  the  solid 
mass,  which  upon  being  softened  by  the  mechanical  ac- 
tion of  these  liquids,  could  be  moved  on  by  the  action 
of  a  peristaltic  stimulant. 

On  the  other  hand,  in  the  case  of  the  cecum,  we  have 
what  may  be  practically  termed  a  blind  pouch,  and  we 
may  not  depend  upon  this,  what  I  choose  to  term,  washing 
action  of  the  fluids. 

In  the  tube-like  intestine,  the  liquid  with  peristalsis 
forcing  it  along,  must  work  its  way  into  the  impaction 
and  disintegrate  it. 

But  in  the  case  of  the  cecum,  when  we  have  this 
large  reservoir  entirely  filled  with  an  impacted  mass,  it 
seems  to  me  that  the  most  natural  course  for  any  fluids 
entering  through  the  illeo-cecal  valve  is  directly  out  by 
way  of  the  nearby  entrance  of  the  colon.  This  theoretic 
sudden  discharge  of  an  abnormally  large  quantity  of 
liquid  into  the  colon,  I  think,  accounts  for  the  prodromic 
diarrhea  described  by  Gofton  and  later  by  Reeks. 

So  far  as  I  could  determine,  this  looseness  of  the 
bowels  did  not  precede  my  cases  but  I  think  that  I  saw 
its  counterpart  in  the  acute  colicky  symptoms  shown  at 
the  onset  of  the  attack,  which  I  attribute  to  the  colon's 
receiving  this  unusual  quantity  of  ingesta  whose  ingredi- 
ents were  not  of  a  type  upon  which  the  colon  is  capable 
of  acting.  Consequently  fermentation,  rather  than  di- 
gestion, ensued  an^  flatulence  was  the  consequence. 


98  COLICS  AND  THEIR  TREATMENT 

Suggested  Plan  for  Treating  Cecal  Impaction 

In  the  event  of  my  again  meeting  with  a  case  of  im- 
paction of  the  cecum  I  have  decided  that  I  shall  de- 
pend principally  upon  water  to  remove  it.  After  having 
made  a  positive  diagnosis,  I  shall  first  thoroughly  empty 
the  remainder  of  the  alimentary  tract  by  saline  purga- 
tives administered  through  the  stomach  catheter  and  with- 
hold all  food.  Following  this  I  shall  use  the  tube  not 
once  but  many  times  a  day  and  each  time  I  shall  pump 
in  just  as  much  water  as  I  may  judge,  by  back  pressure 
on  the  pump,  that  the  horse  will  stand. 

If  this  fails,  after  having  thoroughly  washed  out  the 
rectum,  I  shall  carry  in  through  this  clean  gut  a  trocar 
which  I  shall  plunge  through  the  rectal  wall  into  the  im- 
pacted cecum ;  to  this  I  shall  attache  a  tube  and  pump  in 
a  lot  of  water,  in  an  endeavor  to  mechanically  loosen  the 
obstruction. 

These  two  methods  may  seem  rather  far  fetched  and 
the  latter,  of  course,  is  risky  to  say  the  least;  but  I  am 
satisfied  that  no  common  means  will  relieve  this  condi- 
tion. 

Successful  Non-Surgical  Treatment  for  Impaction  of 
the  Rumen 

In  defense  of  my  plan  to  introduce  a  large  quantity 
of  water  through  the  stomach  tube  I  will  cite  a  similar 
condition,  that  of  true  impaction  of  the  rumen  in  bovines, 
in  which  I  have  heard  very  pleasing  results  from  the  use 
of  this  method. 

I  never  had  a  true  case  of  complete  impaction  of  the 
rumen  recover  without  rumenotomy  until  I  conceived  of 
the  idea  of  passing  a  stomach  tube  far  into  this  great 


IMPACTION  OF  THE  CECUM  99 

reservoir,  which  I  consider  is  in  a  great  many  points 
similar  to  the  cecum  of  the  horse,  and  of  introducing  as 
high  as  twenty  gallons  of  warm  water  containing  saline 
purgatives. 

This  treatment  has  so  far  never  failed  to  effect  an 
evacuation  of  this  organ  except  in  one  case  in  which  I 
afterwards  found  to  have  been  caused  by  tuberculosis. 

Likewise  in  this  disease  I  consider  that  water  in  such 
quantities  as  the  subject  can  be  induced  to  drink  or  that 
can  be  given  by  drench  passes  by  the  full  rumen  and 
enters  the  other  stomach  and  consequently  fails  to  reach 
the  mark  as  would  also  any  medicaments  dissolved  or 
suspended  in  the  water. 

When  conventional  treatments  continually  failed  in  this 
almost  parallel  condition  this  treatment  was  successful 
and  I  think  it  not  improbable  that  it  will  also  do  the  work 
in  impaction  of  the  cecum;  although  in  this  case,  of 
course,  the  stomach  tube  can  not  be  introduced  directly 
into  the  affected  organ,  but  the  trocar  can,  and  I  have 
hopes  of  being  successful  with  it. 


Colics  in  the  Horse* 

BY  DAVID  S.  WHITE,  D.  V.  M.,  COLUMBUS,  OHIO 

DEAN    OF    THE    COLLEGE    OF    VETERINARY    MEDICINE,    OHIO 

STATE  UNIVERSITY 

In  this  paper  I  will  deal  with  colic  in  a  narrow  sense 
only,  using  the  term  to  signify  that  a  given  patient  is 
suffering  from  severe  pain  due  to  some  disorder  of  the 
stomach  or  bowels  or  both.  As  is  frequently  observed, 
colics,  while  usually  acute,  are  sometimes  chronic,  lasting 
for  several  weeks  with  either  continuous  or  intermittent 
pain.  These  colics  are  usually  due  to  some  bowel  lesion 
of  long  standing  (tumor,  stenosis  near  termination  of 
ilium,  chronic  dilatation  of  the  cecum,  hernias)  or  occa- 
sionally helminths.  On  account  of  their  greater  fre- 
quency, only  those  colics  will  be  discussed  which  are 
acute  in  course  and  due  mainly  to  simple  fecal  impactions, 
impactions  complicated  with  displacement,  and  gaseous 
distention  of  the  stomach.  Gastro-enteritis,  a  common 
cause  of  abdominal  pain  in  the  horse,  can  not  be  touched 
upon  for  lack  of  space. 

The  morbidity  of  colic  is  about  10%  of  all  of  the  ail- 
ments of  horses  and  50%  of  their  internal  diseases. 

The  mortality  averages  10%.  The  most  common 
causes  of  death,  according  to  Froehner,  are  the  follow- 
ing: 


*Excerpted  from  an  article  in  the  January,  1914,  issue  of  the   Veterinary 
Alumni  Quarterly   (O.   S.   U,   Columbus). 


102  COLICS  AND  THEIR  TREATMENT 

Displacement  of  the  colon lj/2  % 

Torsion  of  the  small  bowels V/2% 

Rupture  of  the  stomach V/2% 

Simple  impaction 1^2% 

Rupture  of  the  cecum 1% 

Rupture  of  the  colon 1% 

Gastro-enteritis  1% 

Embolism,  tumors,  enteroliths,  hernias,  parasites.  ..  .1% 
From  the  standpoint  of  practice  colic  may  be  classified 
as  follows: 

1.  Acute  dilatation  of  the  stomach. 

2.  Simple  impaction  of  the  intestines  (small  or  large). 

3.  Impaction  complicated  with  displacement  of  the 
bowel. 

4.  Embolic  colic. 

5.  Spasdomic  colic. 

6.  Verminous  colic. 

In  the  space  allotted  to  me  it  would  be  impossible  to 
consider  adequately  all  of  these  various  forms  in  any- 
thing like  proper  detail.  The  following  notes  which  ap- 
ply to  the  first  three  of  the  above  group  may  offer  some 
suggestions : 

Acute  Dilatation  of  the  Stomach — Gastrectasis 

By  this  condition  we  understand  a  sudden  distention  of 
the  stomach  due  to  gas  formed  either  in  the  organ  (pri- 
mary) or  in  the  bowel  (secondary)  due  to  an  unusual 
fermentation  of  the  ingesta.  This  condition  is  very  com- 
mon in  horses,  forming  about  ten  per  cent  of  the  cases 
of  colic. 

Primary  dilatation  is  due  to  over-feeding,  or  more 
commonly  to  irrational  feeding,  especially,  where  large 


COLICS  IN  THE  HORSE  103 

quantities  of  corn,  barley,  bran  or  chop  are  fed.  Horses 
which  are  fed  irregularly,  such  as  cab  horses,  express 
wagon  horses  owned  by  individuals,  etc.,  which  eat  out 
of  a  nosebag  and  are  placed  at  hard  work  too  soon  there- 
after are  the  most  frequent  sufferers.  On  the  other 
hand,  horses  which  are  regularly  fed  or  on  pasture  are 
only  occasionally  attacked.  There  can  be  no  doubt  that 
extremes  in  atmospheric  temperatures,  especially  if  the 
air  is  damp,  may  predispose  to  an  attack.  It  is  com- 
monly observed,  therefore,  during  very  hot  weather  or 
very  cold  weather,  particularly  when  it  is  humid.  Dila- 
tation of  the  stomach  is,  as  noted,  quite  commonly  sec- 
ondary, resulting  from  impaction  of  the  bowel  either 
simple  or  complicated. 

Symptoms. — As  a  general  proposition  gastric  dilata- 
tion may  be  diagnosed,  provided  a  clear  history  of  the 
kind  of  work,  food  and  method  of  feeding  are  obtain- 
able and  a  careful  examination  of  the  patient  made.  In 
most  cases  the  attack  of  gastric  pain  comes  on  just  after 
feeding,  or  more  rarely  during  feeding.  However,  there 
are  exceptions  to  this,  and  not  infrequently  attacks  occur 
as  long  as  seven  to  eight  hours  after  feeding. 

The  patient  is  usually  dyspneic,  which,  depending  upon 
the  degree  of  dilatation,  will  vary.  It  is  usually  well 
marked,  however,  and  due  to  the  distended  stomach's 
interference  with  the  action  of  the  diaphragm.  The  dys- 
pnea is  more  marked  when  the  animal  is  recumbent.  The 
expression  of  the  face  is  usually  staring  and  anxious, 
the  conjunctiva  in  the  early  stages  is  slightly  congested, 
in  severe  cases  cyanotic  and  muddy.  Depending  upon 
the  severity  and  duration  of  the  attack  the  pulse  varies 


104  COLICS  AND  THEIR  TREATMENT 

from  normal  frequency  and  strength  to  weak,  often  im- 
perceptible, going  as  high  as  80  to  100  per  minute.  The 
temperature  varies  between  100°  to  102°  F.,  although 
where  the  condition  is  protracted  it  may  reach  105°  F. 

The  symptoms  of  pain  are  usually  marked  in  the  be- 
ginning of  the  attack.  The  peristalsis  in  nearly  every 
case  is  partially  or  entirely  suppressed,  due  to  the  asso- 
ciated involvement  of  the  bowel.  In  mild  attacks  there 
is  usually  little  or  no  sweating,  but  in  severe  cases  pro- 
nounced general  hyperidrosis  is  observed.  A  symptom 
of  great  diagnostic  value,  but  unfortunately  not  always 
present,  is  esophageal  eructation.  Behrens  in  his  study 
of  142  cases  of  gastric  dilatation  noted  belching  in  only 
48.  Vomiting  is  an  occasional  symptom  which  by  no 
means  speaks  for  rupture  of  the  stomach.  In  not  over 
twenty  per  cent  of  the  cases  of  vomiting  does  rupture 
attend  the  act.  The  most  valuable  aid  to  diagnosis  is  the 
stomach  tube.  Unless  the  gastric  dilatation  is  compli- 
cated with  intestinal  disorder,  a  rapid  disappearance  of 
the  colic  follows  the  use  of  the  stomach  tube. 

According  to  some  authorities,  displacement  of  the 
spleen  is  a  tangible  symptom  of  gastric  dilatation.  This 
organ  may  be  felt  through  the  rectum  where  it  has  be- 
come displaced  posteriorly  lying  in  the  region  of  the  left 
flank.  Inasmuch,  however,  as  similar  displacements  of 
the  spleen  have  been  noted  in  perfectly  healthy  and  even 
fasting  horses,  this  symptom  is  at  least  not  pathognomo- 
nic. 

Treatment. — The  treatment  of  acute  gastric  dilata- 
tion is  mechanical.  The  stomach  tube  should  be  prompt- 
ly passed  to  permit  the  imprisoned  gas  to  escape,  usually 


COLICS  IN  THE  HORSE  105 

bringing  up  with  it  large  quantities  of  the  gastric  con- 
tents. The  stomach  may  then  be  washed  out  (lavaged) 
by  repeated  injections  of  luke  warm  water  to  which  sodi- 
um bicarbonate  has  been  added,  siphoning  out  as  much 
as  possible  after  each  injection,  although  in  old  horses, 
to  avoid  collapse  of  the  patient,  the  water  should  be 
allowed  to  remain  in  the  stomach.  If  applied  early,  this 
method  will  bring  about  recovery  in  nearly  100  percent 
of  the  cases  of  primary  dilatation,  and  fully  50  to  75 
percent  of  secondary  dilatation. 

Simple  Impaction  of  the  Bowel 

This  colic  is  due  to  an  accumulation  of  feces,  which 
remains  more  or  less  stagnant  in  some  part  of  the  bowel. 
It  is  the  most  common  form  of  colic  we  have.  In  the 
Berlin  clinics  nearly  75  percent  of  cases  of  colic  were  due 
to  fecal  stasis.  Behrens  reports  772  cases  of  colic,  of 
which  547  were  simple  impaction.  316  of  these  were 
in  the  small  bowels  and  231  in  the  large.  The  propor- 
tions are  4  to  3. 

Two  forms  of  simple  impaction  may  be  recognized : 
1.  Impaction  of  the  small  bowels.  2.  Impaction  of  the 
large  bowels. 

Impaction  of  the  Small  Bowel. — The  usual  symp- 
toms of  colic  are  present,  i.  e.,  suppressed  peristalisis,  con- 
stipation or  obstipation  and  on  examination  per  rectum 
the  large  bowels  are  found  intact.  In  the  early  stages,  at 
least,  or  unless  the  case  has  been  allowed  to  go  on  neg- 
lected, the  pulse,  temperature  and  conjunctiva  remain 
practically  normal.  Hypodermic  injections  of  arecoline 
usually  afford  relief  in  from  one-half  to  one  hour,  com- 
plete recovery  in  three  to  six  hours.    Unless  relieved,  the 


106  COLICS  AND  THEIR  TREATMENT 

condition  may  last  several  days,  one  attack  of  pain  fol- 
lowing another,  and  death  resulting  from  toxemia,  en- 
teritis or  torsion.  The  temperature,  pulse,  peristalsis  and 
conjunctiva  are  important  warning  signals  to  consider  in 
this  regard.  Under  proper  treatment,  fully  95  percent 
of  the  cases  of  impaction  of  the  small  bowels  recover. 

Impaction  of  the  Large  Bowel. — In  this  condition  the 
feces  accumulate  in  either  the  cecum  or  colon  (pelvic 
flexure,  stomach-like  dilatation)  or  in  the  rectum.  These 
may  each  be  briefly  considered. 

Cecal  Impaction — Chronic  impaction  of  the  cecum  is 
commonly  the  result  of  an  organic  change  in  the  wall 
of  the  bowel.  This  change  consists  in  the  gradual  dilata- 
tion which  induces  impaction  and  as  a  result  hypertrophy. 
In  time  paralysis  follows.  The  dilation  becomes  perman- 
ent and  impactions  frequent.  This  form  of  colic  is  usu- 
ally chronic,  occurring  intermittently,  and  unless  relieved 
takes  a  lethal  termination.  Usually  toxemia,  enteritis  or 
rupture  of  the  cecum  with  peritonitis  causes  death. 

Cecal  impaction  can  only  be  diagnosed  by  rectal  palpa- 
tion. In  the  region  of  the  upper  right  flank  may  be  felt 
an  enlargement  of  about  the  size  of  a  man's  head.  The 
enlargement  is  round,  surface  smooth  and  is  not  sensitive. 
Sometimes  the  bands  of  the  cecum  may  be  felt  on  the 
surface.  The  consistency  of  the  swelling  varies.  It  is 
sometimes  quite  soft,  doughy,  retaining  finger  imprints; 
at  other  times  it  is  firm  and  hard.  The  fixed  position  of 
the  enlargement,  its  size  and  location  in  the  upper  right 
region  of  the  flank  usually  makes  the  diagnosis  not  diffi- 
cult. Error  would  be  possible  only  in  case  there  was 
impaction  with  displacement  of  the  lower  left  colon,  the 


COLICS  IN  THE  HORSE  107 

bowel  extending  over  from  the  left  to  the  right  side  of 
the  abdominal  cavity.  The  impaction  of  the  left  lower 
colon,  however,  usually  occupies  the  right  lower  region 
of  the  flank  and  usually  hugs  rather  closely  to  the  median 
line.  The  shape  of  the  impacted  mass  is  usually  not  round 
but  more  elongated,  and  finally  the  base  of  the  impacted 
cecum  may  be  felt  in  situ. 

Impaction  of  the  Left  Colons — Usually  the  lower  colon 
and  the  pelvic  flexure  are  simultaneously  involved.  When 
the  left  lower  colon  is  impacted,  on  rectal  examination 
one  feels  in  the  left  upper  or  lower  flank  region  an  im- 
pacted mass  usually  just  in  front  of  the  pelvic  inlet  and 
more  rarely  protruding  into  the  pelvic  cavity.  By  care- 
fully feeling  the  swelling  from  right  to  left  one  notes 
upon  the  surface  the  taenia  or  bands  which  designate  the 
left  lower  colon.  The  condition  could  hardly  be  confused 
with  other  parts  of  the  bowel,  as  its  size  is  greater.  It 
is  extremely  difficult  to  determine  whether  both  the  pelvic 
flexure  and  the  left  lower  colon  are  simultaneously  in- 
volved, as  the  crooked  course  of  the  bowel  is  difficult 
to  follow.  An  impaction  of  the  left  upper  colon  is  rec- 
ognized by  its  limited  diameter,  the  absence  of  the  bands, 
the  direction  of  its  course  being  practically  in  a  straight 
line  forward,  while  its  larger  calibre  permits  us  to  dif- 
ferentiate it  from  the  more  tortuous  and  smaller  loops 
of  the  small  bowel. 

Impaction  of  the  Right  Upper  Colon— The  impacted 
mass  is  imprisoned  in  the  stomach-like  dilatation  of  this 
bowel,  beginning  at  its  funnel,  and  extending  anteriorly 
and  including  its  widest  diameter.  As  this  portion  of 
the  bowel  lies  so  far  anteriorly  as  not  be  reached  by  the 


108  COLICS  AND  THEIR  TREATMENT 

arm  except  in  very  small  horses,  the  results  of  rectal 
examination  are  almost  always  negative.  The  clinical 
symptoms  are  very  similar  to  those  of  impaction  of  the 
small  bowel,  so  that  from  a  clinical  standpoint  a  differen- 
tiation is  not  always  possible.  There  is,  in  other  words, 
nothing  characteristic  in  the  symptoms  of  this  form  of 
colic.  As  far  as  the  pulse,  conjunctiva  and  temperature 
are  concerned,  they  are  usually  in  the  beginning  not  much 
affected.  However,  as  in  impactions  of  the  small  bowel, 
after  the  condition  has  prevailed  for  many  hours,  a  gen- 
eral bloating  of  the  small  intestines  results,  so  do  we  find 
in  cases  of  impaction  of  the  right  upper  colon  usually 
considerable  gas  accumulation  in  the  other  colons,  even 
the  left  colons  may  be  found  distended.  This  permits 
us  to  make  a  probable  diagnosis.  In  brief,  the  differen- 
tiation between  impaction  of  the  right  upper  colon  and 
impaction  of  the  small  bowels  would  depend  upon  whether 
the  large  or  small  intestines  became  bloated  later  in  the 
attack.  In  the  early  stages  a  differentiation  is  not  possible. 
III.  Impaction  Complicated  with  Abnormal 
Displacement 
The  following  abnormal  displacements  of  the  bowel 
have  been  noted: 

1.  Torsion  of  the  colon. 

2.  Torsion  of  the  cecum. 

3.  Torsion  of  the  small  intestine. 

4.  Intussusception  of  the  small  intestine. 

5.  Incarceration  of  the  bowel  in  the  inguinal  canal, 
epiploic  foramen,  rents  in  the  diaphragm,  omentum,  me- 
sentery, etc. 

6.  Strangulation  of  the  bowel  from  tumors. 


COLICS  IN  THE  HORSE  109 

All  of  these  pathological  displacements  lead  to  a  sud- 
den occlusion  of  the  bowel  and  fatal  colic.  They  con- 
stitute about  five  percent  of  all  colic  cases.  Displace- 
ment of  the  large  bowel  and  displacement  of  the  small 
bowel  are  of  great  practical  importance  and  may  be  dis- 
cussed as  follows: 

Displacement  of  the  Large  Bowel. — Most  commonly 
this  consists  in  a  rotation  (torsion)  of  the  left  colons 
around  their  long  axis.  On  account  of  their  free  posi- 
tion in  the  abdominal  cavity,  contrary  to  the  colons  on 
the  right  side,  a  certain  predisposition  to  abnormal  dis- 
placement is  present. 

The  exciting  causes  are  usually  primary  impactions 
behind  the  point  of  torsion.  Therefore,  an  impaction  of 
the  upper  right  colon  ("stomach-like  dilatation")  may 
lead  to  torsion  of  the  lower  colons,  or  an  impaction  of 
the  lower  colons,  torsion  of  the  upper  colon.  In  36  cases 
of  torsion  studied  by  Behrens,  29  showed  impaction 
(81%).  In  that  part  of  the  bowel,  which  is  in  front  of 
it,  impaction  seems  to  produce  a  violent  anti-peristaltic 
movement,  which  induces  secondarily  a  torsion.  In 
rare  instances  paralysis  of  the  bowels,  due  to  embolism 
is  the  cause,  and  still  more  rarely  it  is  due  to  the  rolling 
of  the  patient  during  an  attack  of  colic. 

A  correct  diagnosis  of  torsion  can  be  arrived  at  only 
through  rectal  examination.  Very  important  to  consider 
is  the  course  of  the  bands  of  the  left  lower  colon.  In 
place  of  their  normal  straight  course,  the  bands  will  be 
found  bent  spirally  to  the  right  or  the  left.  The  torsion 
is  always  in  the  direction  opposite  to  the  turn   of  the 


110  COLICS  AND  THEIR  TREATMENT 

bands.  For  example,  the  common  torsion  of  the  left 
colons  is  to  the  right;  the  bands  are  twisted  spirally  to- 
ward the  left  in  this  condition.  Besides  the  findings  of 
the  rectal  examination  in  cases  of  torsion,  it  will  be  noted 
that  the  general  condition  of  the  patient  is  rapidly  be- 
coming serious.  This  is  usually  indicated  in  one  to  two 
hours  by  the  change  in  pulse,  peristalsis,  temperature 
and  the  conjunctiva.  There  is  further  profuse  sweating, 
great  prostration,  collapse,  etc. 

If  the  torsion  is  not  soon  removed  death  will  result  in 
six  to  twelve  hours. 

Displacement  of  the  Small  Bowels — Volvulus. — 
Usually  a  primary  impaction  of  a  part  of  the  bowel  be- 
hind the  volvulus  is  the  cause  of  change  in  position.  The 
primary  impaction  may  be  either  in  the  small  or  in  the 
large  bowel.  Volvulus  of  the  jejunum  is  commonly  pro- 
duced by  impaction  of  the  ilium  at  or  near  its  cecal  ter- 
mination. As  in  the  case  of  the  large  bowels,  a  violent 
anti-peristaltic  movement  of  the  bowel  lying  in  front  of 
the  impaction  favors  torsion. 

Contrary  to  the  torsion  of  the  large  bowel,  volvulus 
can  not  be  determined  positively  per  rectum.  A  diag- 
nosis, therefore,  is  only  possible  by  way  of  exclusion, 
and  it  is  always  a  probable  one.  If  on  rectal  exploration 
no  change  can  be  found  in  the  layers  of  the  large  intes- 
tine and  the  condition  of  the  patient  is  rapidly  growing 
bad,  the  probability  of  the  volvulus  is  great.  In  some 
cases  a  secondary  bloating  of  the  small  intestine,  which 
may  be  determined  per  rectum,  points  to  volvulus. 

Volvulus  of  the  small  intestines  is  nearly  always  fatal, 
leading  to  death  in  eight  to  twelve  hours.    Treatment  as 


COLICS  IN  THE  HORSE  111 

a  rule  is  without  avail,  as  attempts  to  relieve  the  animal 
by  laparotomy  have  not  proven  to  be  feasible. 

The  treatment  for  reducing  torsion  in  the  large  bowels 
is  purely  mechanical.  Behrens  has  successfully  reduced 
torsion  of  the  left  colons  (pelvic  flexure)  in  about  60 
percent  of  the  cases  by  rolling  the  patient  in  the  direction 
of  the  twist.     He  recommends  the  following  procedure: 

''Before  making  the  rectal  examination  for  diagnosis  in 
torsion  give  the  patient  a  clyster  of  five  to  ten  quarts  of 
cold  water.  By  this  means  accumulations  of  feces  in  the 
rectum  are  removed,  and  to  a  large  degree  rupture  of  this 
bowel  is  rendered  less  liable.  The  hand  and  arm  of  the 
operator  should  be  thoroughly  smeared  with  soapsuds. 

"The  recognition  of  the  many  parts  of  the  intestine 
that  are  reached  through  the  rectum  is  made  possible  by 
noting  the  different  calibre  and  anatomical  structure  of 
the  parts.  Mistaking  small  intestines  for  the  left  upper 
colon  and  the  cecum  for  the  left  lower  colon  is  possible. 
If  the  left  upper  colon  is  distended  by  gas  or  solid  con- 
tents it  will  be  found  to  be  larger  in  calibre  than  the  small 
bowel.  If,  however,  the  bowel  is  empty  one  can  not  dis- 
tinguish between  them.  When  the  small  intestines  are 
impacted  it  will  be  noted  that  several  folds  or  loops  are 
pressed  toward  the  pelvic  cavity.  To  distinguish  between 
the  left  upper  and  left  lower  colons  it  should  be  borne  in 
mind  that  the  left  lower  colon  is  of  greater  calibre  and 
provided  with  four  bands,  while  the  left  upper  is  smaller 
and  possesses  no  bands.  Mistaking  the  left  lower  colon 
for  the  cecum,  which  is  very  possible,  as  the  calibre  and 
bands  are  very  similar,  can  as  a  rule  be  avoided  by  noting 
the  direction  of  the  bands,  as  even  when  the  cecum  is 


112  COLICS  AND  THEIR  TREATMENT 

displaced  its  bands  may  be  felt  coursing  toward  the  right 
flank  region." 

The  treatment  in  torsion  of  the  left  colon  consists  in 
rolling  the  animal  in  the  direction  of  the  twist.  In  three 
cases  where  a  diagnosis  was  possible  the  patients  were 
rolled  in  the  direction  of  the  torsion.  If  this  did  not  re- 
lieve them,  in  the  opposite  one.  The  horse  was  not  al- 
ways cast  for  the  operation;  by  waiting  sometimes  fif- 
teen minutes  it  would  lie  down  of  its  own  accord.  The 
patient  is  simply  rolled  over  and  over  two  to  fifteen  times 
or  until  relieved.  Keeping  the  hand  of  the  operator  in 
the  rectum  during  the  rolling  is  seldom  advisable  and  is 
dangerous  in  that  perforation  of  the  rectum  may  result. 

This  treatment  is  not  always  successful.  Of  seven 
cases  of  torsion  of  the  left  colons  reposition  was  affected 
in  only  four.  The  remaining  three  did  not  yield  to  treat- 
ment. As  the  result  of  Behrens'  study  and  attempts  at 
this  method  of  treatment  of  torsion  of  the  left  colons, 
he  draws  the  following  conclusions : 

1.  It  is  not  possible  under  all  circumstances  to  diag- 
nose this  displacement  per  rectum.  In  many  cases  the 
loops  of  small  bowel,  distended  and  pushed  toward  or 
into  the  pelvic  cavity,  prevent  adequate  palpation. 

2.  One  is  not  always  successful  in  recognizing  in 
which  direction  and  how  extensive  the  displacement  is. 

3.  Rolling  the  patient,  as  suggested,  is  not  always  suc- 
cessful.    In  general  practice  it  is  not  always  feasible. 


Medicinal  Treatment  of  "Colics" 

BY    E.    L.    QUITMAN,    M.D.C.,    CHICAGO 

PROFESSOR  OF  THERAPEUTICS,   CHICAGO  VETERINARY 

COLLEGE 

GENERAL  CONSIDERATION 

It  is  the  writer's  opinion,  that  in  the  larger  cities, 
"colics"  kill  more  horses  than  all  other  diseases  com- 
bined. The  high  mortality  from  colics,  and  the  enor- 
mous economic  loss,  that  it  entails,  are  due,  in  part,  to 
dosing  by  the  horse  owners,  those  in  charge,  or  on- 
lookers, or  by  the  accommodating  "near  doctor."  To 
this  source,  about  sixty-five  per  cent  of  the  deaths 
from  colics  should  be  charged.  The  thoughtless  and 
unscientific  methods  employed  by  some  veterinarians 
in  the  treatment  of  this  class  of  ailments  is  respon- 
sible for  another  twenty-five  per  cent,  leaving  only  ten 
per  cent  of  the  deaths  to  be  charged  to  absolutely 
hopeless  cases. 

I  would  lay  down  two  laws  for  the  treatment  of  the 
various  forms  of  gastric  and  intestinal  disorders  in 
horses,  that  are  included  under  the  generic  term 
"colic."     They  are: 

1.  Do  not  use  any  treatment  that  may  kill. 

2.  Do  not  use  any  treatment  that  will  mask  the 
symptoms. 

Use  No  Treatment  That  May  Kill 
Among  the  medicinal   agents  prohibited  by  our  first 
law,  i.  e.,  those  that  may  kill,  I  will  include : 
1.     Aloes  and  other  severe  purgatives. 


114  COLICS  AND  THEIR  TREATMENT 

2.  Aconite;  an  agent  that  is  sometimes  used  in 
stock  colic  mixtures,  and  one  that  oftentimes  paralyzes 
the  gastric  functions  and  leads  to  flatulence. 

3.  Drugs  that  evolve  gases  under  certain  condi- 
tions, such  as  ammonium  carbonate  or  sodium  bicar- 
bonate, and  on  that  account  should  never  be  used  in 
stock  mixtures.  When  such  agents  are  administered 
in  gastric  flatulence  (and  stock  mixtures  are  of  course 
liable  to  be  given,  in  any  and  all  types  of  colics),  they 
are  very  liable  to  cause  rupture  of  the  stomach  by  the 
rapid  evolution  of  carbon  dioxide,  when  they  come  in 
contact  with  the  acid,  fermenting  material  in  the  stom- 
ach. This  sudden  increase  of  pressure  in  the  already 
gas-filled  stomach  is  almost  sure  to  rupture  that  organ. 

4.  Croton  Oil;  this  is  a  drug  that  the  horse  is  espe- 
cially susceptible  to,  and  even  when  well  diluted  in 
bland  oils,  it  frequently  gives  rise  to  a  fatal  gastritis 
or  muco-enteritis. 

5.  Irritant  drugs  improperly  diluted.  These  should 
also  be  considered  as  prohibited  by  the  first  law.  The 
writer  knows  of  many  cases  of  gastritis  that  were 
caused  by  insufficient  dilution  of  such  drugs  as  am- 
monium carbonate,  aqua  ammonia,  aromatic  spirits  of 
ammonia,  tincture  of  capsicum,  tincture  of  ginger,  oil 
of  peppermint  and  other  volatile  essential  oils,  etc.,  etc. 

The  administration  of  aromatic  spirits  of  ammonia 
in  capsules  is,  in  the  writer's  opinion,  nothing  short 
of  malpractice ;  first  on  account  of  the  danger  of  such 
capsules  being  broken  in  the  mouth,  and  the  conse- 
quent dire   results   due  to  its  caustic   action,   and  sec- 


MEDICINAL  TREATMENT  OF  "COLICS"  115 

ondly,  because  the  liberation  of  this  drug,  in  one  place 
in  the  stomach,  upon  the  solution  of  the  capsule, 
causes  sufficient  irritation  to  set  up  gastritis,  either 
acute,  subacute  or  chronic. 

Avoid  Bad  After-Effects 

The  fact  that  a  horse  does  not  die  from  the  "colic" 
does  not  prove  that  he  was  properly  treated.  If  he 
emerges  from  the  attack  of  colic  with  first  a  loss  of 
appetite,  later  on  showing  an  indifferent  desire  for 
food,  and  a  constantly  increasing  loss  of  flesh,  it  indi- 
cates, in  ninety-nine  out  of  one  hundred  instances,  that  he 
was  improperly  treated — that  the  treatment  because  of 
its  irritant  character  caused  gastritis. 

Under  the  first  law  for  the  treatment  of  colic  the 
writer  would  also  warn  the  reader  against  the  danger 
of  stock  colic  mixtures,  that  contain  aromatic  spirits  of 
ammonia  and  linseed  oil,  for  the  reason  that,  if  allowed  to 
get  old,  a  caustic,  soft  soap  seems  to  be  formed,  by  the 
action  of  the  alkaline  ammonia  on  the  oil,  and  although 
it  had  when  prepared  a  sufficient  excess  of  oil  to  prevent 
irritation,  upon  standing  for  months  it  frequently  be- 
comes sufficiently  irritating  to  cause  inflammation  of  the 
mucous  membrane  of  the  stomach. 

As  for  aloes,  the  sooner  this  drug  is  discarded  by  all 
veterinarians  as  a  part  of  the  treatment  of  all  forms  of 
colic,  either  before  or  during  the  attack,  or  as  an  after 
treatment,  the  sooner  will  the  mortality,  and  the  disap- 
pointing sequlae,  such  as  muco-enteritis,  enteritis,  super- 
purgation  and  laminitis,  decrease  appreciably. 


116  COLICS  AND  THEIR  TREATMENT 

The  Folly  of  Using  Aloes  in  Colic 

That  elimination  of  the  contents  of  the  stomach  and 
bowels  is  essential  in  the  treatment  of  the  various  forms 
of  gastro-intestinal  affections,  from  spasmodic  colic  to 
the  graver  conditions,  there  can  be  no  doubt,  as  irritating 
contents,  either  bacterial,  chemical  or  mechanical,  is  the 
cause  of  the  various  morbid  conditions  that  give  rise  to 
colic  in  its  manifold  forms. 

But  such  elimination  can  be  secured  more  quickly  and 
safely  by  other  means  than  through  the  action  of  aloes. 
Such  agents  as  physostigmine,  arecoline  and  raw  linseed 
or  castor  oil,  coupled  with,  in  some  cases,  liberal  rectal 
injections,  are  far  preferable. 

Aloes  never  has,  and  never  will,  overcome  impaction 
of  the  bowels;  but  it  has  been  the  cause  of  numberless 
cases  of  this  ailment,  "running  into"  inflammation  of  the 
bowels. 

Aloes  requires  a  period  of  from  eighteen  to  twenty-four 
hours  to  produce  the  first  evacuation  in  a  horse,  and 
furthermore  causes  an  intense  congestion  of  the  posterior 
portion  of  the  intestines,  that  is  the  large  intestines. 

The  folly  of  administering  it  as  an  aid  to  "cure"  colic, 
can  be  seen  by  the  length  of  time  it  takes  it  to  act.  Most 
colic  cases  will  be  well  or  dead  before  it  acts,  so  the 
question  of  its  usefulness  in  the  great  majority  of  cases 
may  be  disposed  of  by  saying  it  is  nil,  for  obviously 
neither  a  well  nor  a  dead  horse  has  any  need  for  the  ac- 
tion of  aloes.  But  in  addition  to  its  uselessness  its  ad- 
ministration is  fraught  with  danger  in  colics.  Suppose  a 
horse  has  suffered  a  severe  attack  of  one  of  the  forms  of 


MEDICINAL  TREATMENT  OF  "COLICS"  117 

colic  and  has  been  ill  for  several  hours ;  under  such  con- 
ditions there  is  almost  sure  to  be  some  congestion  of  the 
bowels,  especially  in  those  cases  that  occur  in  the  spring 
of  the  year,  when  the  weather  is  mild  and  the  water  that 
horses  drink  icy  cold;  conditions  that  give  rise  to  "con- 
gestive colics."  Doesn't  it  look  reasonable  to  assume, 
that  aloes  with  its  irritant,  congestive  action,  will  add  fuel 
to  the  fire,  or  the  spark  to  the  powder,  and  thus  increase 
a  moderate  type  of  congestion  to  an  acute  active  conges- 
tion and  the  consequent  enteritis? 

More  than  twenty  years  ago,  the  writer  dropped  aloes 
from  his  treatment  of  colics ;  he  has  since  been  rewarded 
by  having  but  exceedingly  few  cases  of  enteritis  or  other 
of  the  untoward  sequelae  of  this  class  of  ailments.  I 
am  convinced  that  more  cases  of  enteritis  are  induced  by 
faulty  treatment  than  occur  as  a  primary  disease  or  as 
a  sequel  to  colic  in  any  and  all  of  its  forms. 

Avoid  Anodynes  Except  in  Rare  Instances 

The  second  law  for  the  treatment  of  colics,  do  not  use 
any  treatment  that  will  mask  the  symptoms,  while  broad 
in  its  scope,  can  be  disposed  of  briefly.  Under  this  law 
I  strongly  advise  against  the  use  of  drugs  having  a  dis- 
tinct and  primary  anodyne  action,  like  opium  or  mor- 
phine, for  the  very  good  reason  that  they  allay  the  pain 
but  have  no  curative  effect  on  the  cause,  thus  commonly 
misleading  the  attending  veterinarian  and  the  owner  (who 
is  frequently  requested  to  make  reports  of  the  patient's 
condition  over  the  telephone)  and  the  animal,  though  in 
no  pain,  is  heading  for  an  attack  of  impaction  of  the 
bowels,  and  possibly  still  graver  conditions. 


118  COLICS  AND  THEIR  TREATMENT 

Another  objection  to  the  use  of  anodynes,  including 
cannabis  indica  and  hysocyamus,  lies  in  the  fact  that  they 
delay  and  lessen  the  effects  of  the  quick  acting  cathartics, 
physostigmine  and  arecoline,  although  of  themselves  they 
do  not  actually  cause  constipation. 

There  are  of  course  exceptions  to  this,  as  to  all  rules. 
Occasions  do  occur  in  one's  practice  when  a  patient  is 
suffering  such  acute  pain  as  to  make  him  unruly  to  a  de- 
gree that  it  is  impossible  to  administer  to  him,  immedi- 
ately the  properly  indicated  treatment.  Such  animals 
must  be  given  an  anodyne  hypodermatically  to  render 
them  tractible  enough  for  further  treatment.  Even  for 
such,  I  advise  the  trial  of  three-  or  four-grain  doses  of 
morphine  sulphate  instead  of  the  usual  five-  or  six-grain 
doses.  Naturally  the  smaller  the  dose,  the  less  the  tend- 
ency to  produce  constipation  or  impaction,  and  the  less  it 
will  retard  the  effect  of  the  quick  acting  cathartics  which 
have  become  a  sine  qua  non  in  the  treatment  of  colics. 

Stock  Colic  Mixtures  of  Little  Value 

All,  I  think,  will  acknowledge  that  colic  in  its  generic 
sense  cannot  be  properly  nor  scientifically  treated  by  stock 
mixtures  which  of  necessity  must  be  of  the  "shot-gun" 
variety.  However,  we  are  forced  to  supply  some  of  our 
clients  with  a  "colic  remedy"  for  various  and  obvious 
reasons,  one  of  which  is  to  prevent  them  from  using 
quack  nostrums  and  another  is  to  save  ourselves  from  be- 
ing called  out  at  night. 

This  being  so,  study  the  question  closely  and  omit  drugs 
like  opium,  morphine,  cannabis  indica  and  hysocyamus, 
which   are   non-curative,   and   will   mask   the   symptoms 


MEDICINAL  TREATMENT  OF  "COLICS"  119 

should  the  case  later  demand  your  personal  attention.  In 
addition  they  will  retard  the  effects  of  the  quick-acting 
cathartics,  should  they  be  given. 

Anodynes  and  antispasmodics  which  may  be  substituted 
for  the  above  and  which  do  not  have  their  objectionable 
features  are  belladonna,  stramonium,  acetanilid  and  oil  of 
turpentine. 

It  is  best,  on  stock-mixture  labels,  to  advise  that  not 
more  than  two  doses  be  given  and  that  upon  the  failure 
of  the  second  dose  the  doctor  be  called.  This  limitation 
of  the  number  of  doses  is  imperative  if  they  contain  any 
of  the  poisonous  drugs. 

When  medicine  is  furnished  to  clients  living  many  miles 
from  the  office,  where  many  doses  may  be  administered, 
it  is  doubly  advisable  to  omit  poisonous  drugs  from  the 
mixture.  In  fact  it  is  advisable  to  omit  these  even  in 
city  practice  where  the  ignorant  horsemen  will  not  read 
or  obey  even  the  most  explicit  directions. 
A  Safe  "Colic  Remedy" 

The  suggestions  for  the  possible  use  of  belladonna  and 
stramonium  are  made  more  for  administration  by  the  vet- 
erinarian than  for  use  in  stock  colic  mixtures.  For  a 
stock  colic  mixture  which  is  as  nearly  harmless  as  any 
that  can  be  made,  and  still  be  of  value,  the  following  is 
suggested : 

Acetanilidi  pulv 3  lj  to  nj 

Ol.  Menthae  Piperitae 3  *  J 

Ol.  Terebinthinae. 
/Etheris 


120  COLICS  AND  THEIR  TREATMENT 

Tr.  Zingiberis   aa  g  j  to  i j 

Ac.  Salicylici  3  iij  to  iv 

Ol.  Lini   q.  s.  ad.  §xij 

M. 

Sig.  Give  at  one  dose  (repeat  in  an  hour  if  neces- 
sary). 

The  acetanilid  is  used  on  account  of  its  being  a  non- 
constipating  anodyne.  One  that  will  not  retard  the  ac- 
tion of  eserine  or  arecoline,  and  has  a  beneficial  influence 
in  congestive  conditions  of  the  bowels. 

Tincture  of  ginger  is  preferable  to  tincture  of  capsi- 
cum because  the  latter  is  constipating. 

Spirits  of  nitrous  ether  may  be  used  in  place  of  the 
ether  if  desired. 

The  Quick-Acting  Cathartics 

Under  the  caption  of  general  considerations  it  may 
not  be  amiss  to  discuss  the  comparative  value  of  the  three 
quick-acting  cathartics,  namely — barium  chloride,  arecol- 
ine hydrobromide  and  physostigmine  (or  eserine)  sul- 
phate. 

Barium  chloride,  the  least  desirable  and  most  dan- 
gerous of  this  class,  belongs  to  the  category  of  "kill  or 
cure"  drugs,  and  while  once  enjoying  a  wave  of  great 
popularity,  it  is  now  rapidly  passing  into  a  well-deserved 
oblivion,  with  perhaps  a  faint  occasional  flutter  of  life. 

It  is  administered  in  7^  to  10-grain  doses,  intraven- 
ously (never  subcutaneously  as  it  does  not  act  as  a  ca- 
thartic, and  will  cause  sloughing).  Dissolve  this 
quantity  in  two  to  fou*  a'rams  of  water  and  filter  the 
solution.     Barium  chloride  was  formerlv  used  in  this 


MEDICINAL  TREATMENT  OF  "COLICS"  121 

way  in  15-grain  doses,  but  this  is  excessive.  If  used, 
I  would  advise  that  the  ten-grain  dose  for  jugular 
vein  injection  be  not  exceeded. 

Barium  chloride  is  given  in  from  one-half  to  one  dram 
doses  by  the  mouth.  Occasionally  the  devil-may-care  vet- 
erinarian gives  two  drams,  but  here  again  I  wish  to  ad- 
vise against  the  use  of  more  than  one  dram.  For  oral  use, 
it  should  be  diluted  with  one  pint  to  one  quart  of  water, 
both  as  a  diluent  and  to  prevent  its  too  rapid  absorption. 
Catharsis  is  induced  by  it  in  15  to  30  minutes. 

When  barium  chloride  acts,  it  acts  beautifully,  when  it 
kills,  it  kills  quickly,  and  it  does  the  latter  frequently. 
It  is  intensely  painful  in  its  effect  and  can  bring  in  the 
end  only  shame  and  discredit  on  the  user. 

Arecoline  hydrobromide  has  many  users  and  friends 
in  the  veterinary  profession.  It  is  supplied  the  prac- 
titioner in  tablet  form  and  is  administered  hypoder- 
matically  in  one,  one  and  one-half,  and  two-grain 
doses;  dissolved,  of  course,  in  sterile  water.  It  acts 
in  about  20  to  30  minutes,  causing  considerable  grip- 
ing and  a  greatly  increased  flow  of  saliva,  sometimes 
amounting  to  a  gallon  or  two,  which  is  swallowed  by 
some  horses  and  is  allowed  to  run  out  of  the  mouth 
by  others.  It  usually  causes  from  five  to  seven  evacu- 
ations and  empties  the  rectum  only.  It  also  greatly  in- 
creases the  secretion  of  acid  in  the  stomach,  which  effect, 
coupled  with  the  severe  pain  it  causes,  makes  it  a  danger- 
ous drug  to  use  in  gastric  flatulence. 

I  use  arecoline  hydrobromide  occasionally  in  the 
less  serious  types  of  cases,  in  which  an  active  cathartic 


122  COLICS  AND  THEIR  TREATMENT 

is  indicated;  but  under  no  conditions  do  I  use  it  when 
gastric  flatulence  is  present. 

Physostigmine  sulphate  (also  known  as  eserine  sul- 
phate), if  properly  selected  and  properly  used  is  a 
safe  and  highly  satisfactory,  quick  cathartic.  I  would 
advise  its  purchase  only  in  hermetically  sealed  glass 
tubes  as  the  drug  is  very  delicate,  very  hygroscopic 
and  deteriorates  rapidly  on  exposure.  The  average 
dose  for  country  horses  is  one  grain,  for  city  horses, 
one  and  one-half  grains.  It  is  very  soluble,  but  for 
hypodermatic  administration  is  usually  dissolved  in 
one-half  to  one  dram  of  water.  Tablets  of  this  drug 
are  unstable  in  their  effect;  due  to  both  the  delicate 
nature  of  the  drug  and  to  the  fact  that  in  tablet  mak- 
ing, the  salicylate  of  physotigmine  is  used.  This  salt 
is  not  very  soluble,  and  as  a  consequence,  is  often  ad- 
ministered in  an  incompletely,  dissolved  state  when, 
hypodermatically,  absorption  does  not  take  place.  This 
results  in  failure  to  secure  action  from  it  and  the  un- 
just condemnation  of  a  most  valuable  drug.  It  can 
be  purchased  in  one-half,  one,  one  and  one-half,  two, 
three,  five  and  fifteen-grain  tubes;  however  the  one, 
and  the  one  and  one-half-grain  tubes  are  best  for  gen- 
eral use. 

Tablets  of  physostigmine  benzoate  have  recently 
been  placed  on  the  market;  unlike  the  salicylate,  the 
benzoate  is  very  soluble  and  gives  good  results,  but  I 
cannot  say  as  to  their  keeping  properties.  We  know 
that  the  drug  in  the  sealed  tubes  cannot  deteriorate, 
and  consequently,  pin  our  faith  to  it  in  that  form. 


MEDICINAL  TREATMENT  OF  "COLICS"  123 

Physostigmine  is  slower  of  action  than  arecoline, 
usually  requiring  one  hour  to  produce  catharsis, 
though  occasionally  acting  in  one-half  hour.  It  usual- 
ly causes  some  griping  but  not  as  severe  as  that  pro- 
duced by  arecoline;  quite  often  it  not  only  fails  to 
gripe  but  allays  the  pain  in  15  to  20  minutes  as  though 
it  were  some  powerful  anodyne,  yet  acting  as  a 
cathartic. 

While  physostigmine  is  slower  than  arecoline,  it  is  very 
much  more  thorough,  usually  causing  copious  defeca- 
tion seven  to  a  dozen  times  during  the  first  hour  of 
its  action  and  five  or  six  defecations  during  the  second 
hour,  by  which  time  any  griping  it  may  have  caused 
will  have  ceased,  although  catharsis  continues  for 
from  two  to  four  hours  longer;  resulting  in  as  com- 
plete an  unloading  of  the  intestine  as  can  be  secured 
from  a  full  purgative  dose  of  aloes. 

Unlike  arecoline,  which  is  emphatically  contraindiced, 
physostigmine  may  be  given  in  gastric  flatulence,  how- 
ever, neither  of  these  agents  should  ever  be  given  to 
a  horse  suffering  from  "heaves"  if  it  can  be  avoided, 
though  if  imperative  it  may  be  administered  to  such 
patients  by  breaking  up  the  regular  dose  into  three 
or  four  doses,  given  fifteen  to  twenty  minutes  apart. 
Should  this  so  aggravate  the  heaves  as  to  make  death 
from  dyspnoea  imminent,  its  effects  on  the  bronchi 
can  be  quickly  checked  by  the  administration  hypoder- 
matically  of  two  drams  of  fluid  extract  of  stramonium 
diluted  with  one  ounce  of  water,  or  by  one-fourth  to 
one-half  grain  atropine  sulphate,  I  prefer  the  stramo- 


124  COLICS  AND  THEIR  TREATMENT 

nium  to  overcome  this  spasm  of  the  bronchioles  so  disas- 
trous in  animals  suffering  from  heaves,  because  of  its 
more  lasting  effect. 

An  hour  after  the  first  dose  of  the  antidote,  a  second 
dose  may  have  to  be  administered,  oral  admin- 
istration will  usually  suffice  for  the  second  and  third 
doses,  should  they  be  necessary.  In  using  eserine  or 
arecoline  where  the  patient  is  afflicted  with  heaves,  it 
naturally  is  advisable  that  the  veterinarian  watch  his 
patient  until  danger  has  passed. 

All  quick-acting  cathartics  are  also  more  or  less  liable 
to  produce  abortion  in  pregnant  animals;  this  is  espec- 
ially true  if  they  be  near  full  term. 

SPECIFIC  CONSIDERATION  OF  COLICS 

Without  reference  to  the  symptoms  of  the  various 
forms  of  colic,  which  are  discussed  at  length  in  other 
articles  in  this  book,  we  may  take  up  a  discussion  of  their 
treatment  as  follows: 

Gastric  Flatulence 

Synonyms :  Gastric  tympany,  gastrectasis,  acute  in- 
digestion. 

The  time  was,  and  that  during  my  time,  when  a  case 
of  gastric  flatulence  meant  a  six  or  eight-hour  job  for 
the  veterinarian,  provided  the  patient  survived  that  long, 
but  thanks  to  the  perfection  of  the  stomach  tube,  or  to 
the  discovery  that  a  capsule  of  salicylic  acid,  preferably 
but  not  necessarily,  augmented  by  a  hypodermatic  injec- 
tion of  physostigmine  sulphate  will  relieve  this  condition, 


MEDICINAL  TREATMENT  OF  "COLICS"  125 

thirty  to  sixty  minutes  is  about  the  time  it  now  requires 
to  treat  such  cases. 

Tapping  the  stomach  by  means  of  an  extra  long  tro- 
car and  cannla  was  tried  by  Dr.  Joseph  Hughes  some 
15  or  18  years  ago,  but  was  discarded  as  being  dan- 
gerous and  inefficient. 

The  writer  had  a  stomach  tube  made  to  order  in  Eng- 
land twenty-one  years  ago  but  being  made  of  the  same 
material  and  similar  to,  the  old  light-colored,  linen  cathe- 
ter it  was  stiff  and  awkward  to  pass  into  the  stomach, 
and  was  discarded  as  being  impractical.  It  remained  for 
Dr.  D.  O.  Knisely  to  perfect  and  popularize  stomach 
lavage  in  the  horse  by  means  of  the  rubber  stomach  tube 
and  the  injection  pump.  As  a  full  explanation  of  its 
value  and  uses  may  be  found  elsewhere  in  this  little 
volume,  it  is  not  necessary  to  go  into  a  discussion  of  it 
here. 

The  writer  fully  concurs  with  those  who  place  a  high 
value  upon  the  stomach  tube  in  gastric  flatulence,  but 
does  not  use  it  in  his  practice  except  on  rare  occasions 
on  account  of  its  being  rather  bulky  to  carry,  its  use 
rather  a  "mussy"  operation,  occasionally  producing  quite 
a  hemorrhage  from  the  turbinated  bones  which,  though 
of  no  consequence,  frequently  alarms  the  owner  and  be- 
cause its  use  is  commonly  followed  by  a  severe  cough. 

Drenches  are  often  impossible  of  administration  in 
gastric  flatulence,  due  to  the  eructation  of  gas  forcing  the 
medicine  up  and  out  again.  They  are  dangerous  because 
of  the  frequency  with  which  they  are  forced  up  to  the 
fauces,  and  on  account  of  the  partial  stupor  and  distress 


126  COLICS  AND  THEIR  TREATMENT 

of  the  patient,  they  often  find  entrance  to  the  trachea 
and  cause  a  mechanical  broncho-pneumonia  that  usually 
terminates  fatally. 

The  treatment  that  I  use  and  have  used  for  20  years, 
and  recommend  with  the  utmost  confidence,  is  salicylic 
acid  in  capsules.  I  have  fondly  dubbed  this  "my  vest 
pocket  stomach  tube."  I  administer  it  in  doses  of  one- 
half  ounce.  Not  more  than  two  or  three  cases  in  a  hun- 
dred will  require  a  second  dose. 

If—  Ac.  Salicylici  §ss 

Zingiberis  pulv 3ij 

M.  ft.  caps.  No.  1. 

Sig.  Give  at  one  dose  (repeat  in  one-half  to  one  hour 
if  necessary). 

Owing  to  the  bulkiness  of  salicylic  acid,  it  will  require 
a  capsule  having  a  liquid  capacity  of  V/i  ounces  to  hold 
the  ingredients  prescribed  above;  however,  the  regula- 
tion one-ounce  capsule  can  be  made  to  do,  by  using 
salicylic  acid  alone,  and  packing  it  in  firmly  or  the  above 
prescription  may  be  put  into  two,  one-ounce  capsules  and 
by  discarding  the  short  ends  of  the  capsules  and  moisten- 
ing the  capsule  in  a  line  and  with  a  knife  splitting  the 
capsules  on  one  side  from  top  to  bottom  two  of  these  can 
thus  be  pressed  together  enabling  the  veterinarian  to  give 
both  capsules  at  one  shot. 

Two  drams  of  fluid  extract  of  nux  vomica  may  be 
slowly  poured  onto  the  contents  of  the  capsules  at  the 
time  of  use,  if  desired  and  with  advantage. 

In  addition  to  the  capsule  of  salicylic  acid,  I  admin- 
ister a  dose  of  physostigmine  sulphate,  unless  there  is 


MEDICINAL  TREATMENT  OF  "COLICS"  127 

some  specific  contra-indication  as  previously  noted  in  this 
article. 

I  wish  to  repeat  my  injunction,  do  not  use  arecoline  in 
gastric  flatulence,  for  the  reason,  already  mentioned,  that 
it  commonly  causes  the  death  of  the  patient. 

I  consider  salicylic  acid  the  most  powerful  antiferment 
we  have,  that  is  applicable  for  use  in  a  horse's  stomach. 
It  not  only  checks  the  fermentation  but  in  some  inex- 
plicable way  seems  to  get  rid  of  the  gas  already  in  the 
stomach. 

Eserine,  in  one  to  one  and  one-half  grain  doses,  is  used 
to  empty  the  stomach  and  bowels. 

Spasmodic  Colic 

The  condition  usually  diagnosed  as  spasmodic  colic 
may  be  of  a  comparatively  simple  nature  and  yield  to 
very  simple  treatment,  such  as  a  three,  four  or  five-grain 
dose  of  morphine,  or  a  dram  or  two  of  fluid  extract  of 
belladonna  or  to  some  warming  up  medicament  of  a  car- 
minative nature  as  alcohol,  whisky,  tincture  of  ginger, 
tincture  of  capsicum,  oil  of  turpentine,  spirits  of  cam- 
phor or  spirits  of  nitrous  ether,  etc.,  etc. ;  but  what  seems 
to  be  a  simple  spasmodic  colic,  is  frequently  the  earlier 
stage  of  some  more  serious  condition,  and  even  if  it  is 
only  spasmodic  colic,  it  denotes  the  presence  in  the  intes- 
tinal tract  of  an  irritant  which  should  be  expelled  by  the 
use  of  a  prompt  cathartic  (eserine  is  preferred  by  the 
writer)  and  the  administration  of  a  carminitive  or  a  mix- 
ture similar  to  the  one  recommended  as  a  type  of  stock, 
colic  mixtures  on  pages  119  or  128. 


128  COLICS  AND  THEIR  TREATMENT 

Intestinal  Flatulence 

Enterocentesis  should  be  resorted  to  in  this  ailment  if 
danger  is  imminent.  The  indications  call  for  the  quick 
purgatives  (eserine  or  arecoline)  and  the  following: 

3J — Ol.  Mentha?  piperita? 3ij 

Ol.  Terebinthinae. 

^Etheris. 

Spts.  Ammon.  Arom. 

Tr.  Zingiberis   aa  §ij 

Ac.  Salicylici 3vj 

M.* 
Sig.    Give  one-half  at  a  dose  in  a  pint  of  water,  re- 
peat in  three-quarters  of  an  hour  if  necessary. 
Avoid  anodynes. 

This  form  of  colic  is  frequently  followed  by  impaction 
due  to  the  exhaustion  of  the  muscular  coats  of  the 
bowels,  resulting  from  the  stretching  they  have  been  sub- 
jected to  during  the  flatulence.  Eserine  sulphate  is 
doubly  valuable  in  this  instance,  to  eliminate  the  fer- 
menting material  and  to  stimulate  secretion  and  peris- 
talsis and  the  exhausted  muscular  coats  through  their 
nerves  thus  warding  off  impaction. 

Making  it  an  almost  invariable  rule  to  use  eserine,  or 
possibly  arecoline,  in  these  cases  will  well  repay  the 
practitioner  by  saving  him  the  worry  and  danger  inci- 
dental to  impaction  of  the  bowels. 

Naphthalin  is  a  useful  intestinal  antiseptic  and  anti- 
ferment  in  two  to  three-dram  doses.     Autointoxication 

•Note:  Dissolve  the  salicylic  acid  in  the  tincture  of  ginger  to 
prevent  a  too  violent  chemical  reaction  between  it  and  the  aro- 
matic spirits  of  ammonia. 


MEDICINAL  TREATMENT  OF  "COLICS"  129 

following  impaction  is  an  especial  indication  for  naph- 
thalin. 

Gastro-Intestinal  Flatulence 

When  one  has  to  deal  with  this  ailment  enterocentesis 
should  be  resorted  to  immediately  to  give  breathing  room 
and  prevent  toxemia  from  absorption  of  the  gases;  then 
administer  the  treatment  recommended  for  gastric  flatu- 
lence. Should  the  intestines  again  bloat,  then  give  the 
mixture  mentioned  under  intestinal  flatulence. 

Do  not  fail  to  use  eserine  at  the  start. 

In  a  number  of  cases  of  intestinal  flatulence  or  gastro- 
intestinal flatulence,  a  fever  may  prevail  for  several  days. 
This  denotes  autointoxication  and  should  be  combated 
by  a  liberal  dose  of  raw  linseed  oil  (one  and  one-half  to 
two  pints),  and  the  administration  of  naphthalin  in  two- 
dram  doses,  three  or  four  times  daily. 

Betanaphthol  is  also  very  good  as  is  phenyl  salicylate 
or  salol  and  hexamethylenamine  (commonly  known  as 
urotropin)  ;  all  may  be  used  in  about  two-dram  doses. 

The  first-named  is  preferred  by  the  writer. 

Impaction  of  the  Bowels 

This  ailment  is  one  that,  if  properly  treated,  rarely 
destroys  life,  yet  many  losses  occur  from  it,  due  to  treat- 
ment being  forced.  I  refer  especially  to  the  use  of  aloes 
and  other  powerful  purgatives. 

When  there  is  impaction,  there  is  paralysis  of  the 
bowels;  this  paralysis  differs  in  no  material  way  from 
paralysis  of  a  leg.  Would  you  expect  to  cure  paralysis 
of  a  leg  with  repeated  doses  of  aloes?     I  dare  say  not. 


130  COLICS  AND  THEIR  TREATMENT 

Does  the  physician  expect  to  overcome  paralysis  of  an 
arm  with  irritating  purgatives?     He  certainly  does  not. 

In  impaction,  besides  the  paralysis  of  the  bowels  (whole 
or  partial),  we  have  the  hard  dry  mass  of  feces  with 
which  to  contend. 

The  danger  from  impaction  of  the  bowels  lies  in : 

1.  Death  from  starvation  and  exhaustion. 

2.  Death  from  autointoxication. 

3.  Death  from  gangrene   (rare). 

4.  Death  from  enteritis. 

The  first  can  be  prevented  only  by  overcoming  the 
ailment  before  this  condition  is  possible.  Many  veteri- 
narians to  try  to  force  bowel  movement  with  aloes,  which 
not  only  commonly  fails,  but  is  a  potent  factor  in  bring- 
ing on  the  fourth  danger  (enteritis). 

Let  us  analyze  the  error  of  the  aloes'  treatment  in 
impaction  of  the  bowels. 

Picture  in  your  mind  a  large  portion  of  intestinal 
tract,  rich  in  blood  supply,  filled  with  a  large,  hard,  dry, 
heavy  mass  of  feces  weighing  40  to  50  or  60  pounds, 
harsh  and  irritating,  practically  a  foreign  body  lying  in 
one  place,  mechanically  interfering  with  the  flow  of 
blood  or  in  other  words  causing  congestion  over  a  great- 
er or  less  area  of  the  intestinal  tract. 

Now  comes  a  dose  of  aloes,  which  itself  must  be  acted 
upon  by  the  bile  before  it  really  can  have  a  purgative 
action  and  with  impaction  there  is  usually,  in  fact,  I  think 
always,  a  sluggish  liver,  which  being  so,  renders  void  the 
cathartic  action  of  the  aloes.  Unfortunately  this  is  not 
true  of  the  irritant  action  of  this  drug;  whether  acted 


MEDICINAL  TREATMENT  OF  "COLICS"  131 

upon  by  the  bile  or  not,  aloes  causes  an  intense  conges- 
tion of  the  large  intestines;  thus  aloes  adds  congestion  to 
congestion  and  consequently  makes  enteritis  a  great  deal 
more  likely  to  supervene  upon  a  case  of  impaction  when 
it  is  used. 

The  second  danger  can  be  combated  by  the  addition 
of  intestinal  antiseptics,  the  writer's  favorite  being  two- 
dram  doses  of  resublimed  naphthalin  administered  three 
or  four  times  daily.  This  drug  may  be  given  in  capsules 
or  suspended  in  linseed  oil. 

The  third  danger  can  be  combated  only  indirectly — 
by  removing  the  cause  of  the  impeded  circulation  as 
quickly  as  possible,  but  in  attempting  to  do  this,  we 
should  not  substitute  the  more  common  danger — en- 
teritis by  forced  treatment,  i.  e.,  from  the  use  of  aloes 
and  similar  irritating  purgatives. 

The  above  remarks,  regarding  forced  treatment, 
have,  perhaps  led  the  reader  to  think,  that  the  writer's 
treatment  is  slow,  requiring,  probably  five,  six  or  more 
days  to  re-establish  bowel  movements.  I  wish  to  as- 
sure you,  that  such  is  not  the  case;  that  one,  two  or 
three  days  is  about  the  time  required  for  the  treat- 
ment of  impaction  of  the  bowels  in  ninety-nine  out  of 
one  hundred  cases.  These  periods  comparing  with 
three,  six  and  nine-day  cases  treated  by  the  old-line 
methods. 

Since  the  writer  has  made  eserine  an  essential  part 
of  his  treatment,  for  practically  every  form  of  colic, 
impaction,  following  colic,  has  almost  ceased  to  occur 
in  his  practice;  however,  impaction  does  occur  as  a 


132  COLICS  AND  THEIR  TREATMENT 

primary  disease  and  if  the  case  comes  into  my  hands 
still  showing  slight  peristalsis,  the  following  is  admin- 
istered : 

IJ — Physostigmine  sulphate   gr.  jss 

Pilocarpine  hydrochloride gr.  ij 

Strychnine  sulphate gr.  j 

Distilled  water   q.  s.  3iij 

M.  et  fiat  sol. 
Sig.     Administer  one  dram   (or  one-third  of  the 
solution)  every  twenty  minutes  until  all  is  used. 

This  commonly  is  all  that  is  necessary,  except  per- 
haps a  quart  of  raw  linseed  oil  is  sometimes  bene- 
ficial. Should  it  fail,  or  if  the  impaction  is  fully  estab- 
lished, the  following  is  administered : 

IJ — Fluidextracti   Nucis   Vomicae §j 

Fluidextracti  Pilocarpi §ij 

Fluidextracti  Colchici  sem §ss-j 

Fluidextracti  Physostigmatis §j 

Aquae  q.  s.  ad ovnJ 

M. 

Sig.     Give  one  ounce  every  one  and  one-half  to 
two  hours,  diluted  with  an  ounce  or  two  of  water. 

If  there  is  considerable  pain,  one-half  dram  doses 
of  fluidextract  of  belladonna  may  be  added.  This 
drug  also  stimulates  intestinal  secretion  after  a  brief 
diminution;  or  instead  of  the  repeated  one-half-dram 
doses  of  belladonna,  a  single  two-dram  dose  may  be 
given  and  repeated  in  three  or  four  hours  if  necessary. 

Should    there    be    considerable    congestion    of    the 


MEDICINAL  TREATMENT  OF  "COLICS"  133 

bowels  or  liver  or  great  pain  present,  instead  of  the 
above  prescription,  I  put  the  patient  on  the  following : 

1$ — Nucis  Vomicae  pulv §j 

Acetanilidi  pulv 5jss-ij 

Sodii  phosphatis gxvj 

M.  et  ft.  chart.  No.  VIII. 
Sig.     One  powder  in  four  or  five  ounces  warm 
water,  every  two  hours. 

This  prescription  will  be  found  serviceable  in  pain- 
ful cases  of  impaction  in  place  of  the  preceding  one, 
but  the  first  one  is  generally  to  be  preferred. 

Now  as  to  the  actual  purgative.  I  never  use  any 
other  than  oil.  Usually  raw  linseed  oil — one  quart 
night  and  morning.  Occasionally  in  the  more  serious 
cases  a  quart  every  eight  hours.  Flood  them  with  oil 
is  my  slogan. 

In  some  cases  I  use  a  pint  each  of  linseed  and  castor 
oil  at  a  dose  or  sometimes  a  quart  of  castor  oil  is  given 
once  daily  and  a  quart  linseed  oil  once  daily. 

Rectal  injections  of  two  or  three  ounces  of  glycerin 
every  two  or  three  hours  are  often  of  value  as  glycerin 
promotes  secretion  and  peristalsis  and  by  its  slight  irri- 
tant action  makes  the  animal  strain  slightly,  which  by 
virtue  of  the  contraction  of  the  abdominal  muscles 
brought  into  play,  acts  somewhat  in  the  manner  of  an 
abdominal  massage  and  aids  in  overcoming  the  condition. 

Should  the  patient  be  already  straining,  then  glycerin 
injections  should  not  be  used. 

Rectal  injections  of  water,  soap  suds  and  water  or 
soap  emulsion  or  water  containing  an  ounce  of  turpen- 


134  COLICS  AND  THEIR  TREATMENT 

tine  to  each  bucket  of  water  are  useful  and  of  great 
value  if  thrown  well  up  into  the  bowels.  Injections  by 
means  of  a  syringe,  no  matter  how  large  are  of  little 
value  as  it  does  not  go  in  far  enough. 

The  writer  attaches  a  stomach  tube  to  a  continuous 
flow  injection  pump  and  prefers  warm  water  to  cold  wa- 
ter for  this  purpose.  The  tube  is  well  lubricated  and 
pushed  gently  up  into  the  bowel  for  about  six  feet,  stop- 
ping for  a  moment  if  the  patient  strains.  Should  the 
tube  apparently  meet  with  an  obstruction  blocking  fur- 
ther progress  after  going  in  only  part  way,  pump  in  one 
or  two  gallons  of  water  which  either  lubricates  or  balloons 
the  bowels,  thus  facilitating  insertion. 

Now  flood  them  with  water,  not  a  bucketful,  but  as 
much  as  you  can  get  into  them,  15  to  20  or  even  30 
gallons,  the  more  the  better,  and  the  more  there  will 
be  retained  to  soften  up  the  hard  fecal  mass.  One 
such  intestinal  lavage  is  worth  dozens  of  the  usual 
bucketful  enemas.  To  do  this  once  or  twice  daily  is 
sufficient  as  the  patient  will  at  intervals  pass  the  water 
mixed  with  some  feces  for  three  to  six  hours  after  the 
injection. 

Some  veterinarians  contend  that  injections  of  cold 
water  are  more  stimulating  to  peristalsis  than  hot  water 
and  when  convenient  run  a  hose  attached  to  a  hydrant 
or  faucet  up  into  the  bowel,  six  or  more  feet  and  turn 
on  the  water,  slowly  at  first  and  gradually  increasing  the 
flow.  This  rapidly  reduces  any  fever  that  may  be  pres- 
ent and  no  doubt  has  its  value. 

I  practice  it  occasionally,  when  it  is  difficult  or  im- 


MEDICINAL  TREATMENT  OF  "COLICS"  135 

possible  to  get  sufficient  warm  water  for  the  purpose,  but 
prefer  warm  water,  inasmuch  as  I  have  seen  several 
severe  chills  brought  on  by  the  cold  injection,  and  I 
have  not  seen  it  produce  any  better  results  than  warm 
water. 

While  I  admit,  and  advocate  the  value  of  liberal  rectal 
injections,  I  do  not,  by  any  means,  use  them  in  all  cases 
as  I  find  the  internal  treatment,  with  the  liberal  use  of 
oil  usually,  saves  me  the  trouble  of  the  rectal  injections. 
Superpurgation 
Give  starch  or  flour  gruel  to  drink  instead  of  w'ater. 
A  hypodermatic  injection  of  morphine  sulphate  may 
be  of  value  for  immediate  and  temporary  action.  Give 
the  following  also : 

~R — Ac.  Hydrocyanici  Dil. 
Chloroformi 

01.  Menthae  Piperita?   aa  gss 

01.  Terebinthinae  Rectif.   .  .    5Jss 

Tr.  Capsici. 
Spts.  Camphorae. 

Tr.  Opii   aa  giij 

M. 

Sig.  Give  two  ounces  in  one-half  to  one  pint  starch 
or  flour  gruel,  every  two  or  three  hours.  (Less  often 
as  improvement  is  shown.) 

Enteritis 
There  is  no  doubt  that  true  enteritis  envolving  a  con- 
siderable portion  of  the  intestines  is  invariably  fatal,  but 
I  am  of  the  opinion  that  where  it  exists  only  in  a  small 
localized  area  that  recovery  may  occur. 


136       -  COLICS  AND  THEIR  TREATMENT 

Externally  to  wrap  the  entire  barrel  of  the  horse  up 
in  hot,  wet  woolen  blankets,  covered  by  an  impervious 
dry  covering,  is  of  the  greatest  value;  but  unfortunately 
this  highly  valuable  procedure  is  impossible,  or  at  least 
impracticable  in  most  cases  in  veterinary  practice,  as  we 
usually  cannot  procure  sufficient  blankets,  enough  hot 
water,  and  enough  help.  Furthermore,  the  unwieldiness 
of  our  patient  who  is  so  frantic  from  pain  that  it  is 
resistant  to  enormous  doses  of  morphine  make  this  part 
of  the  treatment  rarely  available. 

Where  the  hot,  wet  blanket  treatment  cannot  be  carried 
out,  apply  the  following  liberally  over  the  patient's  abdo- 
men. 

3$ — 01.  Sinapis  3ij 

Ol.  Terebinthinae gij 

Aq.   Ammonii  Fort §j-ij 

Ol.  Gossypii  sem q.  s.  ad.  gviij 

M. 

Sig.     Apply  thoroughly  once  only. 
.Internally,  the  following  is  recommended : 

I£ — Fluidextracti  Aconiti 3j 

Fluidextracti  Belladonnas  3iij 

Aquae   q.  s.  ad.  §vj 

M. 

Sig.     Give  one  ounce  every  hour  till   effect,  then 
less  often. 

Acute  Muco-Enteritis 

In  this  ailment  the  prescription  recommended  for  en- 
teritis is  to  be  given  every  two  hours  in  conjunction  with 


MEDICINAL  TREATMENT  OF  "COLICS"  137 

two  to  four-dram  doses  of  bismuth  subnitrate  and  one- 
half-pint  doses  of  raw  linseed  oil,  every  four  hours. 

Intussusception 

Great  stimulation  of  peristalsis  with  eserine  or  areco- 
line,  together  with  the  use  of  liberal  doses  of  linseed  oil, 
is  the  only  medicinal  treatment  that  holds  out  any  hope 
in  this  ailment. 

If  it  is  possible  to  get  fluid  well  up  into  the  bowel,  a 
pound  of  bicarbonate  of  soda  dissolved  in  a  gallon  or  two 
of  water  may  be  injected  (using  a  long  tube  like  a  stom- 
ach tube)  followed  by  about  a  quart  of  dilute  acetic  acid 
(or  vinegar)  mixed  with  a  gallon  of  water;  this  will 
evolve  considerable  gas  and  the  consequent  ballooning  of 
the  bowel  may  prove  of  value  in  some  cases. 


Veterinary  Medicine  Series 

Edited  by  D.  M.  Campbell,  D.  V.  S. 


SPRINGTIME  SURGERY 

D.  M.  Campbell,  D.  V.  S. 

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POULTRY  DISEASES  AND  THEIR 
TREATMENT 

B.  F.  Kaupp,  M.  Sc.,  D.  V.  S. 

$1.50 


COLICS  AND  THEIR  TREATMENT 

D.  M.  Campbell,  D.  V.  S. 

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BIOLOGIC  DIAGNOSTIC  METHODS 
AND  BIOTHERAPY 
Dr.  L.  W.  Fetzer 

In  Preparation 


DISEASES  OF  THE  DOG 

C.  G.  Saunders,  V.  S.,  B.  V.  Sc. 

In  Preparation 


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